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HISTORY 



AN EPIDEMIC FEVER. 



_ HISTORY AND DESCRIPTION 



cY 



S 



OF AN 



EPIDEMIC FEYER,, 



C0MM6NLY CALLED 



SPOTTED FEVER, 



WHICH PREVAILED AT GARDINER, MAINE, IN THE SPRING OF 1814, 



Bt E. HALE, Jr. M.D. M.M.S.S, 




BOSTON : 

PRINTED BY WELLS AND LILLY; 
1318. 



TO 

BENJAMIN VAUGHAN Esq.M.D. L.L.D. 

DEAR SIR, 

The kindness and friendship with which 
you have honoured me, as well as the strong 
interest you feel in the promotion of science ; 
and especially that of the profession to which 
I belong, induce me to inscribe to you this 
little volume. You have seen much of the 
disease, which I have here attempted to de- 
scribe, and will feel how inadequate any des- 
cription is, to give a full representation of its 
various and evanescent features. You have 
seen too, what anxious watching, and diligent 
investigation, it incessantly required from the 
physician ; and how little time it left him, to 
mature his observations upon its character. 
You will, therefore, I doubt not, be disposed 
to receive with candour and indulgence this 
attempt to transmit to others, an account of 
the principal phenomena which it exhibited. 

DEAR SIR, 

Your sincere friend 

and very obedient servant, 

E. HALE, jr. 

Boston, October 1, 181$. 






vr. 



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PREFACE. 



Several treatises upon the Spotted Fever 
have already been published in this country. 
But as their object has been to give such an 
account of it, as would apply to its general 
character, as it appeared in different places ; 
they could not of course take notice of many 
of the modifications, which it acquired from 
various local circumstances. It has been my ob- 
ject in this volume, to give a more clinical view 
of the disease ; to exhibit it in its varieties, 
as it appeared to the physician at the bedside 
of his patient, rather than to seek its place in 
a regular system. 

The materials from which the description 
and treatment of the disease are given, were 
taken at the time. At the close of every day, 
I recalled to mind the circumstances of each 



Vlll PREFACE. 

case, for which T had prescribed, and recorded 
them in my note-book. By this means I had 
a daily journal of every case, and could after- 
wards compare them with each other ; and 
with the state of the weather, as shewn by 
the Meteorological Journal, which was also 
kept at the same time. A particular account 
of the situation and symptoms of each patient, 
and of the remedies prescribed, was in this 
manner recorded, until near the close of 
March ; when the number became so great as 
to make it impossible to do it so fully. The 
similarity of the more important symptoms in 
the greatest proportion of cases, also rendered 
a continuance of so particular a journal less 
necessary. I afterwards generally mentioned 
only the time and manner of the attack, and 
such other circumstances in the course of the 
disease, as were peculiar in their nature, or 
of less frequent occurrence. 

This statement explains the reason that so 
few instances of coma are given among the 
cases, although I have considered it as mak- 
ing one of the stages of the disease. The 
prevalence of this symptom was much less 
general, in the early part of the Epidemic sea- 



PREFACE. IX 

son, than it was at a later period. But my 
minutes of most of the cases, late in the sea- 
son, are not sufficiently particular for publi- 
cation. Had the cases of coma been less fre- 
quent in proportion to the others, I should 
nevertheless, have been disposed to regard it 
as constituting a distinct stage of the disease ; 
in as much as it appeared in most, or all of the 
cases in which the character of the disease 
was suffered to be fully developed ; and espe- 
cially as the symptoms which attended it, were 
many of them, in a great measure peculiar to 
that stage. 

The situation of a country physician, ren- 
ders it necessary for him to unite much of the 
business of an apothecary, with that which 
properly belongs to his profession. He must 
not only prescribe the remedies, but must also 
prepare the medicines, and put them into 
doses. From this cause, some of the prescrip- 
tions were stated with less precision in my 
journal of cases, than if they had been writ- 
ten for another to follow ; and minute and un- 
important changes in the medicines, were not 
always mentioned. In consequence of this, 
rather less variety in the treatment, appears in 



X PREFACE. 

the cases given in this volume, than was 
actually exhibited in practice ; but the differ- 
ence relates only to such slight particulars, as 
were unimportant in their nature and effects. 

I have given a considerable number of cases 
at full length, in order that the reader may be 
able to judge for himself, of the accuracy of 
the description of the disease, and the cor- 
rectness of the observations which I have 
made upon it. These cases are taken from 
my note-book with only slight verbal altera- 
tions ; and, as at the time when the Epidemic 
prevailed, I had but partially formed my 
opinions respecting its nature, there was of 
course no chance for the correctness of the 
records, to be affected by any theoretical par- 
tialities. " There is at all times," says Dr. 
Hall, " something in individual cases, on which 
more reliance is placed, than on any gener- 
alization of facts ; for whilst the former are 
alone presented to our observation by nature, 
the latter is apt to partake of the bias of opin- 
ion, and of the imperfection of every produc- 
tion of the human mind."* 

* Hall on Diagnosis. Preface, page xxiii. 



PREFACE. Xi 

I make no pretensions to originality, in the 
course of treatment which was adopted for 
the cure of the disease. It was principally 
derived from the general principles which are 
to guide us, in the management of all diseases, 
according to their character and symptoms. 
I had then had opportunity to read but little, 
of what had been previously published res- 
pecting the Epidemic. I had, however, ob- 
tained some benefit from these treatises ; and 
I owe much to the suggestions of a highly re- 
spected friend, not in the profession. 



TABLE OF CONTENTS. 



INTRODUCTION. Page 

General remarks 1 

Face of the country, of the District of Maine . . 3 

Climate 4 

Situation of Gardiner 6 

Its inhabitants ....... 8 

Prevailing Diseases ....... 10 

Sketch of Diseases from 1813 to 1817 . . . 15 

Cases of fever in 1817 . . . ... 24 



CHAPTER I. 

ORIGIN AND PROGRESS OP THE EPIDEMIC. 

Its prevalence in the vicinity .... 29 

Commencement in Gardiner 30 

Termination 32 

Other Diseases 33 

Connexion of the Epidemic with changes of weather 34 

Meteorological and Pathological Tables ... 38 

CHAPTER II. 

DESCRIPTION AND SYMPTOMS OP THE FEVER. 

General description 49 

Division into stages 50 

Access 51 

Rapidity of the attack . . . . . . 51 



UV CONTENTS. 










Cases of the access ... 58 


Duration of the first stage 








65 


The vomiting stage 








67 


Perspiration .... 








68 


Peculiar desire for cold water 








71 


Frequency of the vomiting 








71 


Its duration .... 








72 


Comatose stage 








73 


Manner of death 








75 


Frequency of the comatose stage 








76 


Its duration .... 








78 


The convalescence 








78 


Symptoms of recovery 








79 


Eruptions .... 








81 


Carbuncles 








82 


General Observations 








87 


Anomalous symptoms 








88 


Relish for Tobacco 








90 


Affections of the larynx 








91 


Organs exempt from the disease 








92 


Spots 








95 


State of the mind .... 








96 


Crisis 








98 


Duration of the disease 








100 


Number of fatal cases 








101 


Other diseases during the Epidemic 








102 


Second attack of fe ver 








103 


Manner of spreading 








103 


Appearances after death 








109 


CHAPTER III. 











TREATMENT OF THE FEVER. 



General Treatment 

Particular remedies, Venesection 



111 

126 



CONTENTS. 



XV 



Blistering 126 

Fomentations *28 

Frictions 12 9 

Emetics 129 

Cathartics 131 

Diaphoretics * 32 

Stimulants, Cinchona I 36 

, Gentian 138 

, Quassia and other vegetable tonics . . 139 

, Acids 140 

9 Metallic tonics 140 

, Wine . . 141 

, Brandy . . . . . .141 

, Opiates 143 

, Cordials 144 

Diet 144 

Regimen 146 

CHAPTER IV. 

CASES OF THE EPIDEMIC. 



I. 


Case of a young woman 


149 


II. 


A young married woman 


152 


III. 


A boy eleven years old . 


152 


IV. 


A boy six years old . . . . 


154 


V. 


A young woman about eighteen 


154 


VI. 


A married woman about forty 


168 


VII. 


A healthy man about thirty 


170 


VIII. 


A boy four years old 


174 


IX. 


A girl of eighteen .... 


176 


X. 


An infant, thirteen months old 


177 


XI. 


A girl five years old ... 


178 


XII. 


A man aged thirty-three years 


180 


XIII. 


A young woman of twenty-five 


181 


XIV. 


A married woman about thirty 


183 



XVI 



CONTENTS. 



XV. 


Another about the same age 


188 


XVI. 


A young married woman 


190 


XVII. 


A married woman about thirty 


194 


XVIII. 


A boy four years old . . . . 


197 


XIX. 


A young unmarried woman 


198 


XX. 


A gentleman of eighty years 


201 


XXI. 


A lady of about forty . 


205 


XXII. 


A man about thirty-five . 


207 


XXIII. 


A married woman about thirty-five 


212 



CHAPTER V. 

REMARKS UPON THE TREATMENT AND CASES. 

Upon the general result . 

Fatal cases. 

Similarity of the different cases . 



220 
221 

222 



CHAPTER VI. 



REMARKS ON THE NATURE OP THE DISEASE. 

Character of the Fever 226 

Fever complicated with inflammation . . . 236 

Congestion at the commencement .... 239 

Contagion . . . . ' . . . . 240 

The Epidemic the same, as has prevailed in other places 242 

Its name 244 

Conclusion 245 



INTRODUCTION. 



A.N Epidemic in many respects similar to that, 
whose history is detailed in the following pages, 
prevailed extensively throughout New England, 
during the years 1812, 1813 and 1814. Where- 
ever it appeared, its ravages were severely felt. 
The variety and deceptive nature of its symptoms 
often eluded the skill of the Physician, while the 
quickness of its operations, frequently left him 
little to contemplate but its fatal termination. 
The dread which it has inspired, under the name 
of the Spotted Fever, will scarcely be forgotten so 
long as memory or tradition shall last. 

How far this was the same disease, as that, 
which prevailed at Gardiner in the Spring of 
1814, I shall not at present stop to inquire. It 
is well known that peculiarities of climate, local 
situation and local habits have an important in- 
fluence in modifying diseases ; and it is by no 

1 



2 INTRODUCTION. 

means unreasonable to suppose, that local diseas- 
es also materially affect, and vary the character of 
those, which are more general. The principle, 
first noticed by Sydenham, is now pretty gener- 
ally received, as an established law of nature ; that 
Epidemics in their progress overpower all other 
diseases, and assimilate them to themselves. Yet 
it does not follow, that thev are not in their turn 
influenced by the diseases, whose principal fea- 
tures they destroy. On the contrary, it is at least 
probable, that while their characteristic symptoms 
remain, they are so modified, as in many cases 
to assume a very different appearance. It would 
be a very curious inquiry, to what extent an 
Epidemic derives its character from the inherent 
nature of the disease, and how far that character 
results from the local complaints, with which it 
comes in contact in its progress. A satisfactory 
answer to this inquiry, were it possible to obtain 
one, would doubtless do much to quiet the dis- 
putes among Physicians, respecting the nature 
and treatment of these diseases. But the data, 
upon which such an answer must be founded, are 
not to be obtained in regard to any Epidemic, 
that has ever prevailed. It would require a par- 
ticular historical description of the disease in a 
great variety of places, together with an accurate 
medical topography of each place : and these are 
circumstances, to which the attention of the pro- 
fession has been but little directed. 



INTRODUCTION. 3 

Before I proceed, therefore, to the history, 
which is the main object of this treatise, it will 
be proper to notice some of the circumstances, 
which may be supposed to have influenced and 
modified the Epidemic, it describes. In this point 
of view, the face of the country, climate, local sit- 
uation, local habits and prevailing diseases, are 
all entitled to some consideration. I shall not 
pretend to enter into a full discussion of these 
subjects ; but shall only offer such observations, 
connected with my principle design, as a resid- 
ence of less than five years enabled me to make. 
This is the more necessary in the present in- 
stance ; as the climate of the District of Maine is 
little understood, and frequently misrepresented 
by those, who live out of the District. 

The face of the country throughout the District 
of Maine is for the most part hilly, though rare- 
ly mountainous. Hills and valleys are irregu- 
larly interspersed in every part of the country. 
On the banks of the Rivers, they in many places 
assume a more regular appearance, rising and 
falling, like the waves of the sea. The hills in 
these instances frequently terminate on the river 
by an abrupt precipice. The vallies between 
them extend onlv a short distance, but soon rise 
to the elevation of the surrounding country, 
which is much higher than the level of the 
river. 



1 INTRODUCTION. 

The sea coast is pretty generally rocky, and 
apparently, barren. The interiour is much less 
rocky, and is for the most part abundantly fruit- 
ful. The soil is various, being in some few places 
sandy, more frequently clayey, and still more 
extensively loamy. Its fertility is sufficient to 
yield a liberal return to the labours of the hus- 
bandman, although from the recent date of the 
settlements, the state of cultivation is very im- 
perfect. Except on the sea-coast, and a few 
towns in the south-west part of the District, the 
towns have all been recently settled, very few of 
them being more than forty years old, and most 
of them still more modern. Of course, extensive 
forests abound in every part of the District. Per- 
haps no country in the world is better supplied 
with water, than this. Every portion of it is inter- 
sected by rivers, and smaller streams, and ponds, 
which furnish extensive advantages for inland 
navigation, as well as for the purposes of health 
and convenience. 

The climate varies in temperature, from the 
severe cold of winter to the extreme warmth of 
summer — a range by the thermometer, of from 
several degrees below the zero of Farenheit, to 
80 or 90 above it. Although exceedingly cold 
in winter, and warm in summer, it is much less 
subject to frequent and violent changes of tem- 
perature, than the more southern parts of the 



INTRODUCTION. O 

country. It is rather remarkable for its uniform- 
ity. The winters are cold and long ; but the 
steadiness of the cold lessens the perception of 
its severity. The transition from winter to sum- 
mer is rather sudden, with the intervention of 
only a short period of the disagreeable weather 
of early spring. During the spring and sum- 
mer, vegetation is rapid and vigorous. Rains, 
which are rare in winter, are generally suffi- 
ciently abundant in summer. A severe drought 
is an unusual occurrence. The heat of summer 
is almost as remarkable as the cold of winter ; 
but on the Kennebeck river, (and I believe on 
the other rivers,) it is always tempered in the af- 
ternoon by a river breeze, which dispels the 
languor produced by the heat, and gives a de- 
lightful freshness to the atmosphere. This is 
usually followed by a calm, serene evening. It 
is remarkable, that vegetation does not seem to 
be at all impeded by the coolness of the air, pro- 
duced by the river breezes. 

The atmosphere, especially during the winter 
season, is clear and still. Violent winds are ex- 
ceedingly uncommon, and in the cold weather, 
never occur. Nothing can exceed the serenity, 
transparency, and brilliancy, of a cold winter's 
evening on the Kennebeck. Not a vestige of a 
cloud is any where to be seen — not a vapour to 
obstruct the sight, which seems to penetrate into 



6 INTRODUCTION. 

the very immensity of space. Even the smoke> 
which rises from the villages does not intermix 
with the surrounding air, but, as if fearful of con- 
taminating its purity, it stands congealed by the 
cold, in a column surmounting the chimneys from 
which it issues. There is scarcely a motion in 
the air to disturb the universal stillness. The 
whole scene leaves an impression of purity and 
grandeur, unequalled by any thing else, that I 
have ever, witnessed. The atmosphere retains 
much of its purity and serenity through the sum- 
mer months, though with less constancy and bril- 
liancy. There was a remarkable exception to 
its usual transparency, in the summer of 1816, 
during a drought, which was said to be the most 
severe, ever known in the District of Maine. For 
several days the whole atmosphere was so obscur- 
ed by smoke and fog, that the sun was hardly 
visible, or, if at any time it appeared in sight for 
a few minutes, its deep red appearance only serv- 
ed to render the darkness more gloomy. This 
darkness was generally attributed to the smoke 
from the forests, which had taken fire, by various 
accidents, in consequence of the drought ; but 
with how much correctness, I do not pretend to 
determine. 

The preceding observations apply to a great 
part of the District of Maine, as well as to the 
town of Gardiner. This town is situated on the 



INTRODUCTION. 1 

west side of Kennebeck river, about forty miles 
from its mouth, in north latitude 44° 14' and west 
longitude 69° 44', and contains between 1800 and 
2000 inhabitants. Its principal village is, at the 
mouth of the Cobbossee-Contee, a small river, 
which empties into the Kennebeck. This river 
rises from a chain of ponds of considerable ex- 
tent ; and in the last mile of its course, furnishes 
by its falls an abundant supply of water power, 
capable of being applied to the purposes of the 
arts and manufactures. It is already made use 
of in a variety of manufacturing establishments, 
although to a very limited extent, in comparison 
with what the advantages admit of. 

The Kennebeck is navigable for small sea ves- 
sels to Augusta, seven miles above Gardiner; 
and is subject to tides a little farther. The mean 
difference, at Gardiner, between high and low 
water, is about seven feet. The depth of water, 
below this place, is sufficient to permit the access 
and departure of loaded vessels of nearly two 
hundred tons burthen, though the navigation is 
somewhat obstructed by rocks and shoals in some 
places. The river is closed by ice during the 
winter. The mean time of closing, for the last 
twenty years, has been the 28th of November ; 
and the mean time of opening in the spring, for 
the same period, the 6th of April. The mean 
time of closing during the last ten years was 



8 INTRODUCTION. 

rather later, than it was the first ten years of that 
period. In the time of opening there has been 
no material alteration of this kind. It is a rare 
occurrence for the ice to break up, and the river 
to close a second time in the course of the same 
winter. 

Except the inhabitants of the village at the 
mouth of the Cobbossee-Contee, the people of 
Gardiner are generally farmers. Each one 
owns a small farm, and cultivates it with his own 
hands. The richness of the soil and the vicinity 
of a market furnish an abundant encouragement 
for their labour. There are, however, some pe- 
culiarities in their character, as compared with 
the farmers of the older towns in the country. 
Most of them, having removed here from differ- 
ent parts of the country, since the incorporation 
of the town in 1803, they have not had time to ac- 
quire that similarity of habits and customs, which 
is usually found in this class of people. The in- 
conveniences, to which they were exposed, when 
they first encountered the labours of making 
new settlements, have led them to disregard many 
of the common comforts of life. Others, having 
been long accustomed to obtain their support 
from the produce of the forest, are but slowly re- 
claimed from the irregular and improvident habits, 
to which their mode of life has formerly subject- 
ed them. There is a considerable number, who 



INTRODUCTION. H 

well sustain the regular and orderly character of 
New England farmers. But there are many 
others, who, although their character and condi- 
tion are fast improving, still retain much of the 
hardiness and improvidence of the first inhabi- 
tants of a wild country. 

The inhabitants of the village are traders, me- 
chanics, and manufacturers, with characters and 
habits as various as their employments. Many 
of the mechanical arts, requiring a considerable 
degree of bodily fatigue and exposure, are of a 
nature to inspire those who are engaged in them, 
with a sort of contempt for the luxuries, and even 
for many of the comforts of life. Their hardi- 
ness and habitual vigour render them insensible 
to inconveniences, which in other situations would 
be considered essential to health and enjoyment. 
This is more especially the case with those who 
are employed in the saw-mills, in the manufac- 
ture of boards. The nature of their business ex- 
poses them constantly to great fatigue, by night 
as well as by day, and often to labour in the water 
for several hours in succession. Yet they are in 
general a healthy, vigorous class of men, and ap- 
pear to catch their full share of the enjoyments 
of life as they pass through it. There is also a 
considerable number of persons, who have been 
familiarly conversant in general society, and 



10 INTRODUCTION. 

whose habits and customs of course need no par- 
ticular notice. 

From the preceding observations, it will na- 
turally be inferred, that the diseases to which the 
inhabitants of the District of Maine are most sub- 
ject, are those of inflammation, or at least such 
as proceed from a phlogistic diathesis. This may 
perhaps be true in general, although, during the 
time I resided in Gardiner, it was so only to a 
very limited extent, in that place and its vicinity. 
Rheumatisms, especially chronic rheumatisms, 
were very common. But excepting these, dis- 
eases of inflammation were exceedingly rare ; and 
in those which occurred, there was such a tender 
cy to prostration of strength, that much caution 
was necessary, in the use of depleting remedies. 
Almost all of the cases of fever, which 1 saw r , 
partook more or less of the character of that de- 
scribed in this treatise. 

It is by no means true, however, that they have 
always been of this kind. In 1804 and 1805, an 
Epidemic prevailed in Gardiner and the vicinity, 
of a very different character. I have not had a 
very particular description of it : but from the 
course of practice, which was most efficacious in 
subduing it, it is evident that its characteristic 
was a strong tendency to inflammation. The 
Physicians who treated it the most successfully, 
used frequent bleedings, and gave large portions 



INTRODUCTION. 1 1 

of Jalap and the submuriate of mercury daily, 
until the symptoms remitted, which often requir- 
ed twenty-one days ; and at the same time, allow- 
ed only the lightest species of nourishment, and 
that in small quantities. So successful was this 
mode of treatment at that time, that it became 
habitual, with a considerable number of practi- 
tioners, till they seemed almost to forget, that 
there were other remedies in the materia medica ; 
and the powder of Jalap and submuriate of 
mercury has become a common family medi- 
cine. 

From the best information I can obtain, the 
inflammatory diathesis appears to have prevailed, 
until within two or three years of the commence- 
ment of the epidemic of 1814. Whether the 
change from inflammatory to typhoid diseases 
was sudden or gradual in its progress, I have 
not the means of ascertaining. From the time 
that I commenced practice there, in the spring of 
1813, the fevers were invariably those of debility, 
and continued to be more or less so, till the 
autumn of 1817, when they became more inclin- 
ed to inflammation. 

The peculiarities in the constitution of diseases, 
so well defined, and so accurately described by 
Sydenham, although generally acknowledged by 
medical writers, since he brought the subject in- 



12 INTRODUCTION. 

to notice, do not appear to have excited the at- 
tention which they deserve. It is very observ- 
able, that diseases, whose general characters are 
so similar as to be known by the same names, in 
different seasons require very different modes of 
treatment. A fever, which at one period shall 
require powerful and repeated evacuations, at an- 
other time, will bear them with great difficulty. 
A striking example of this kind is given by Dr. 
Rush, in his accounts of the yellow fever at Phi- 
ladelphia, in different years, from 1793 to 1803. 
Even in those diseases which have a more fixed 
character, the same thing takes place, to a con- 
siderable extent. The various local inflamma- 
tions, although they always demand bleeding, and 
other antiphlogistic remedies, in proportion to 
their severity, require much more caution in their 
application, at some periods than at others. There 
are some seasons, when little else seems requisite 
to the restoration of health, than to reduce the 
system from its inflammatory to its natural state. 
The patient passes almost directly from a state of 
high inflammation to that of health ; or with the 
intervention of only a very short period of de- 
bility. There are other seasons, when in the 
same disease, and in persons of the same habits, 
if evacuations are prescribed incautiously, the 
patient sinks suddenly into a state of debility, 
more alarming, and more difficult to cure, than 
the inflammation which preceded it. 



INTRODUCTION. 13 

Few persons will perhaps be disposed to agree 
with Sydenham in attributing this change in 
the character of diseases, to changes in the state 
of the air. If corresponding phenomena had been 
known to take place in the atmosphere, they 
would do but little in explaining the effects at 
tributed to them. Much less, since their exist 
ance is altogether hypothetical, should we resort 
to them for an explanation, which can add noth- 
ing to our knowledge of the facts. That such 
changes do take place in the constitution of dis 
eases, is sufficiently established by an attentive 
observation of their history and symptoms, at dif- 
ferent periods. The causes of the change seem 
beyond the ken of human knowledge ; and it is 
useless to seek them in idle speculation, where 
observation and experiment cannot lead us. In 
a practical view, these changes are of the great- 
est importance. Every disease being more or 
less influenced by the prevailing constitution of 
diseases, it is necessary to take this into consider- 
ation, before we can make up our prescriptions, in- 
telligibly and satisfactorily. We must not only 
look at the individual case before us, but must also 
bear in mind those which have preceded, as well 
as those which are cotemporary with it. Every 
case of disease may be considered as having some 
degree of relation to those which surround if, 
however dissimilar in their general appearance 
and character. Hence it is, that a physician who 
contents himself with ascertaining only the ge 



14 INTRODUCTION. 

neral character of the disease to which he is called, 
and prescribes for it upon authority, will often be 
disappointed of the result he anticipates, while 
he who diligently investigates all the phenomena 
connected with it, and regulates his practice ac- 
cordingly, will be more successful in its manage- 
ment. 

It is exceedingly to be regretted that this sub- 
ject has so little excited the attention of physicians 
and medical writers. Since the history which 
Sydenham has left us of the constitutions of the 
diseases of his time, although the accuracy of his 
descriptions, and the importance of his observa- 
tions, seem to be fully allowed, yet very few have 
imitated his example, and delineated the patho- 
logical changes, and peculiarities of the periods 
in which they have lived. We have treatises on 
particular diseases, and systems of practice, in 
abundance ; but we have no continued history of 
diseases and their phenomena, which will con- 
nect those of one period with those of another, 
and exhibit the relation between those of diffe- 
rent kinds, which occur at the same time. A 
series of such histories, while it would furnish us 
with the means of tracing the origin and progress 
of some diseases, and the decline and disappear- 
ance of others, would enable us, with more satis- 
faction than we can now do it, to compare the 
phenomena and treatment of such as come under 



INTRODUCTION. 15 

our own observation, with those which have been 
subject to the management of our predecessors. 

I shall close this introduction with a concise 
historical sketch of the more important diseases, 
which occurred in my practice, during my resi- 
dence in Gardiner, 

I commenced practice there early in May 
1813. Towards the close of that month we had 
several cases of severe catarrh, or rather pneu- 
monia, complicated with bowel complaints. It- 
was confined to children of from four to seven 
years of age. It began with a severe cough, with 
pain in the chest and dyspncea, pain in the head 
and other symptoms of fever. In a day or two, 
there was nausea and vomiting, pain in the bow- 
els, and not unfrequently diarrhoea. The num- 
ber of cases was not great ; and the termination 
was favorable in all of them. The disease was 
treated by blistering, emetics and cathartics, ex- 
pectorants and alteratives, according to the va- 
riation of the symptoms. 

The summer was remarkably healthy. One 
severe case of pneumonia in an adult, occurred 
in July ; excepting which, my practice was al- 
most confined to occasional calls to slight affec- 
tions, teething children and casualties. The 
autumn was much the same. A singular tumoui 



16 INTRODUCTION. 

in the left hypogastriuni of a boy five Or six 
years old, was the only case worth noticing. It 
was for some time, of a doubtful character ; but 
at length suppurated, was opened, and healed 
without difficulty. 

In December, a case of sudden death occurred 
in consequence of violent anger ; but I was not 
permitted to examine the body, to ascertain the in- 
ternal injury. Early in January 1814, I had 
one case of acute rheumatism, and one of severe 
pneumonia, which, however, terminated favor- 
ably. About the middle of this month, I was 
called into a family in Pittston, several miles dis- 
tant, in which were several cases of genuine ty- 
phus fever, as described by authors. Neither 
the disease nor the treatment had any thing very 
peculiar in them. The patients all recovered. 

At the same time, I had a case of a singular 
disposition to the formation of abscesses in a 
very young infant. The mother had been affect- 
ed with psora, received from a domestic, about 
the sixth month of her pregnancy ; but had cur- 
ed herself, as soon as it was discovered. Whether 
this had any thing to do with the subsequent dis- 
ease of the child, I do not pretend to determine. 
The infant seemed perfectly well, until it was 
about three weeks old, when an eruption com- 
menced, having very little of the appearance 



INTRODUCTION. 17 

of psora however, which soon increased into small 
abscesses. These abscesses shewed no disposition 
to ulcerate through the skin. Nor could they 
be made to do it, by any application for that 
purpose : but constantly extended themselves 
under the integuments, until the matter was eva- 
cuated by an opening with the lancet. Even 
after an opening was made, unless the discharge 
was very free, and aided by compresses, the ab- 
scess would rather incline to extend farther, than 
to heal. The matter discharged was generally 
bland pus, and very copious in quantity. More 
than thirty abscesses formed and were opened in 
succession, before the child recovered. The 
general health in the mean time was less affected 
than might have been expected. The strength 
was supported by an infusion of cinchona, after 
the discharge had become profuse, at the same 
time that the bowels were care fully regulated, and 
alteratives occasionally given. In three or four 
weeks the child recovered. It became very fat 
soon after, but seemed to be in perfect health. 

In February the Epidemic began, which is the 
subject of the following pages. After it ceased 
as an Epidemic, a few cases of fever occurred, in 
the course of the summer and autumn, which, al- 
though they preserved many of its features, were 
too unfrequent, and too different from it in many 

3 



i 8 INTRODUCTION. 

respects, to be considered as a continuance of it 
The fever had more tendency to inflammation, 
at least to phlegmonous inflammation, than had 
been manifested during the Epidemic. There 
was not that tendency to debility, and that ex- 
treme exhaustion from the use of depleting reme- 
dies, which there had previously been. Evacua- 
tions were more freely required, and were borne 
much better. I have to regret the loss of two 
very valuable patients in the autumn of this year, 
by fever complicated with severe local affections. 

In June, I had a case of genuine acute rheu- 
matism, which continued for several weeks with 
considerable severity ; and another in October. 

Through the winter, there were a few cases 
of fever, some of which were severe, and of a 
character nearly similar to those last described. 
As the cold weather advanced, however, it be- 
came necessary to use depleting remedies with 
more caution, and to administer tonics more 
freely, than during the summer and autumn ; and 
the few cases that occurred towards spring, as- 
sumed more the appearance and character of the 
Epidemic of the preceding year. A case in De- 
cember shewed very strikingly the unfavorable 
effects of an unseasonable exhibition of cathartics. 
The patient had been sick three days when I wai* 
called, and had taken a powerful dose of jalap 



INTRODUCTION. I 9 

and submuriate of mercury, two days before, 
which had then hardly ceased its operation. At 
my second visit, 1 found her determined to re- 
peat the cathartic, although I could see nothing 
in her situation or symptoms, which indicated it. 
I had too little influence to prevent her from fol- 
lowing her own inclination ; but succeeded in 
inducing her to substitute a little rhubarb for a 
part of the jalap and submuriate, which she had 
already prepared before I arrived. By this 
means I reduced the quantity about one half. 
Notwithstanding the reduction however, the me- 
dicine produced a hypercatharsis, which very 
nearly destroyed her life, and which could not be 
subdued, by any means which I thought it pru- 
dent to adopt, until nearly a fortnight afterwards. 
When it yielded, it ceased rather abruptly, but 
without any unpleasant consequences. 

In the spring of 1815, we had again several 
cases of pneumonia, complicated with bowel com- 
plaints. They were at this time principally con- 
fined to teething children. One or two cases 
proved fatal, and some others recovered with 
difficulty. The most efficacious mode of treat- 
ment was, after scarifying the gums, if they were 
swollen, to blister the chest, give an emetic of 
Ipecacuanha and submuriate of mercury, and 
to keep up the action of the bowels with small 
doses of the same submuriate, at the same time 



20 INTRODUCTION. 

giving expectorants, and the milder tonics, par- 
ticularly infusion of quassia, as the symptoms 
might indicate. 

In the months of May, June and apart of July, 
a fever prevailed in a small neighbourhood, which 
in some respects resembled the Epidemic of the 
preceding year, although it differed from it in 
some important particulars. Like that, it bore 
evacuations badly ; yet they did not produce such 
an overwhelming state of exhaustion and sinking, 
as they had done the year before. The disease, 
although severe, was less rapid in its progress, and 
less sudden in its changes of appearance and cha- 
racter. The first case was in May, of a young 
man, who had been for several years subject to 
scrofulous affections. He was relieved of the 
fever without much difficulty, principally by the 
use of alteratives ; but after he had become able 
to ride out, he was seized with a diarrhoea, w T hich 
suddenly reduced him very low, in spite of all 
the remedies I could give him. The usual pre- 
scriptions for such an affection, had scarcely any 
effect, though administered very freely. His 
tongue had become black, his teeth and lips were 
covered with a black sordes, and other symptoms 
of approaching death had appeared, when suspect- 
ing the diarrhoea to proceed from scrofula, I gave 
him the solution of muriate of lime in pretty 
large quantities, with tincture of opium. The 



INTRODUCTION. 2i 

effect very far exceeded my expectations. His 
bad symptoms soon disappeared, and in a few days 
he was rapidly convalescent. 

Soon after this, two young men were taken 
sick in the same family, during my absence. 
They were treated with evacuants, principally 
cathartics, and died, each about the twentieth 
day. The other cases all terminated favourably, 
by the use of alteratives and tonics, care being 
taken at the same time, to preserve the first 
passages in good order. There were very few 
cases of fever in town this summer, except in this 
family and the immediate vicinity. The latter 
part of the summer and autumn were very 
healthy. The months of August and Septem- 
ber particularly, scarcely furnished a case of dis- 
ease of any kind. Indeed the remainder of this 
year was free from every thing worthy of notice 
in this sketch. 

A case of acute rheumatism in the winter of 
1816, was treated by bandaging, upon Dr. Bal- 
four's plan. The bandages evidently gave ven 
great relief from the pain ; and thus diminished 
the sufferings of the patient, while other mea- 
sures were in operation to remove the disease. 
Yery little else occurred, except the unimportant 
cases and casualties which are perpetually re- 
curring in country practice, until April, when 



Z % 2 INTRODUCTION. 

a pulmonary affection, with bowel complaints, 
again made its appearance among teething chil- 
dren. The number of cases was not great ; but 
they were generally very severe. They were 
treated, as Ihe similar disease had been the year 
preceding, and in most cases with success, though 
in two instances it proved fatal. In one of them, 
however, nothing had been done to relieve the 
child, until the appearance of the convulsions 
which immediately precede death. 

I had only two or three cases of fever, this 
spring, which were very similar in character to 
those of 1815; and in May, a severe case of 
ophthalmia. Through the summer my practice 
consisted principally of occasional calls. Only 
one case of any importance occurred. This 
was a fever complicated with a spasmodic affec- 
tion of the leg, which at one time threatened to 
become a tetanus, but was subdued by the usual 
anti-spasmodics, combined with the treatment 
for fever. 

There was nothing the following autumn, nor 
in the winter and spring of 1817, which requires 
a particular notice here. I had one case of 
ophthalmia in January, and some slight rheuma- 
tisms, and a considerable number of various chro- 
nic affections in the course of the spring ; but 
they had nothing very peculiar in them. 



INTRODUCTION. 23 

In the summer following, a disease of a more 
important character made its appearance, and at 
one time, threatened to become extensive in its 
ravages. Its course, however, was checked rather 
suddenly by the approach of cool weather ; and 
the number of cases was not large. It was a fe- 
ver, but of a very different character from those 
heretofore mentioned, and requiring a very dif- 
ferent course of treatment. The several cases 
exhibited a great variety of appearances ; but 
they agreed in general, in requiring evacuants 
much more extensively, and stimulants more 
sparingly than any fevers which I had seen. In 
a few w T eeks I bled more patients than I had, at 
any time before since I commenced practice ; and 
this arose, not from any change in my opinion 
respecting the propriety of bleeding in fevers ge- 
nerally, but from an alteration, as I believed, in 
the character of the fevers which came under 
my observation. At the same time, it was neces- 
sary to use evacuations with much caution, to 
prevent the strength from sinking too low. The 
disease seemed to be on a point between requir- 
ing a decidedly depleting, and stimulating course 
of remedies. In the earlier cases particularly, 
much cautious investigation, and anxious watch- 
ing were requisite, to manage them satisfactorily. 
I had the pleasure, however, of seeing them all 
terminate favourably, which came under my care 
where I had the control of the treatment. 



'24 INTRODUCTION. 

I found one bleeding, at the commencement of 
the disease, sufficient. This was generally fol- 
lowed by an emetic, which was sometimes re- 
peated, and by a liberal exhibition of antimonial 
diaphoretics. Cathartics were also given freely, 
whenever the symptoms appeared to indicate 
them ; and tonics as soon as the febrile excite- 
ment was diminished. As the excitement declin- 
ed, the patient in almost every case, sunk into a 
comatose state, from which he was always reliev- 
ed by the application of cold water to the head, 
and the internal use of stimulants. Blisters were 
at first tried for this symptom, but with very little, 
or no effect. 

There were two cases in which the symptoms 
were rather anomalous, and sufficiently remarka- 
ble to deserve a more particular notice. The 
first was a stout, athletic man, who had been se- 
veral days sick with severe pain in the head and 
back. He had been bled, and had taken a pow- 
erful cathartic, by which the pain was nearly re- 
moved. Still he seemed in great distress, though 
he could not refer it to any particular part. He 
slept very little, but lay tossing upon the bed 
continually. His tongue was at first coated, but 
had become nearly natural. His pulse was of a 
natural frequency, and rather feeble. His skin 
was dry ; and his countenance expressive of the 
deepest agony. At length, by giving him very 
large doses of antimonials, with the aid of exter- 



INTRODUCTION. 25 

nal sudorifics, I succeeded in procuring a free per- 
spiration, which completely relieved him of his 
distress. As soon as this had taken place, the 
usual symploms of fever, quick pulse, coated 
tongue, &c. made their appearance, and were re- 
moved after a few days, by the remedies which 
were successful in other cases. 

The other case referred to, was a man of a feeble 
constitution. I was called to him the first day. 
He had the usual symptoms of fever, but not 
very severely. I gave an emetic and antimonials. 
As his pulse was feeble, and there was no symp- 
tom which seemed particularly to require it, I de- 
clined bleeding him, although he wished it. The 
next day he sent to another physician, who was 
not aware that I had been called, until he arrived 
at the house, w r hich was at a considerable dis- 
tance ; and reluctantly consented to prescribe 
without my being present. The symptoms of 
fever had now, in a great measure, disappeared, 
and given place to others, resembling those of 
paralysis. He bled him, and directed frictions 
with a solution of the meloes vesicatorii. The 
third day, at the particular request of this phy- 
sician, the sick man was again put under my care. 
His pulse was now slow and feeble — skin dry — 
tongue slightly coated. His countenance was fix- 
ed, with a very peculiar expression, which I know 
not how to describe. He had complained of no 

4 



-U INTRODUCTION. 

pain, since the first day, when he had had a little in 
(he head, which was relieved by the emetic. But 
the symptom, which was peculiarly noticeable, 
was an entire loss of the power of voluntary mo- 
tion. There was no rigidity of the muscles, and 
no dimunition of heat or of sensibility ; yet he 
could not impart the least motion to a limb, or 
even to his head. When raised upon his feet, he 
could stand, as he had been doing that morning, 
but as soon as he attempted to walk, he fell per- 
fectly helpless upon the floor. In like manner, 
if his head fell upon one side, while he was sit- 
ting upon the side of his bed, he was unable to 
raise it, although he could keep himself erect, 
when he had once gained that posture. He could 
not move a finger or a toe in the least degree. 
He spoke with a little difficulty ; but breathed 
well, and swallowed with ease. He had a slight 
sensation of numbness in his limbs, which he 
compared to a slight degree of the feeling which 
is called a sleepiness of the limbs. His mind was 
perfectly clear, and he was totally free from every 
thing like torpor or coma. 

I still considered this as a case of fever, and 
believed the febrile action to be in a manner con- 
centrated upon the nervous system, as in the 
preceding case it had been upon the brain. I 
accordingly directed large doses of a powder of 
Ipecacuanha and camphor, with a small portion 



INTRODUCTION. 27 

of opium, to be given every four hours ; and a 
pretty Jarge blister to be applied to each leg, 
and as soon as the action of the skin was excited, 
to be removed to another place, without full vesi- 
cation. Stimulating frictions were also ordered 
to be diligently applied over the whole body. 

Upon visiting him again the next morning, 1 
was mortified to find, that because the first pow- 
der had produced a slight nausea, no more had 
been given ; and the other remedies had been 
very carelessly applied. My patient was now in 
a hopeless state. The loss of power had extend- 
ed to the muscles of respiration and degluti- 
tion, and of voice. He breathed with great dif- 
ficulty, and could scarcely speak intelligibly. 
The whole surface of the body was covered with 
a profuse perspiration ; and a watery fluid flow- 
ed in considerable quantities from his mouth, 
which came apparently from his lungs. He had 
not lost his sensibility nor his powers of mind, 
and the heat of the body was not materially dimi- 
nished. Some attempts were made to rouse the 
system to action, by powerful stimuli ; but they 
were ineffectual, and he expired the same day. 
I could not obtain leave to have a dissection. 

I had afterwards another case, in which an ex- 
crutiating pain in the foot was attended with un- 
defined general distress, thirst and dry skin. I 



28 INTRODUCTION. 

bled pretty largely, and prescribed antimonials. 
The next day the pain was completely gone, and 
my patient had only a slight fever remaining, 
which disappeared in a day or two. 

Cases of this fever continued to occur occasion- 
ally, though not very frequently, through the 
whole of the autumn, until December, when I 
removed from Gardiner. 



CHAPTER I 



HISTORY OF THE ORIGIN AND PROGRESS OF THE 
EPIDEMIC 

At the commencement of the year 1814, there 
was nothing at Gardiner, to indicate the approach 
of the Epidemic, that was to follow, unless it 
was its prevalence in some towns in the vicinity. 
The year preceding had been abundantly fruit- 
ful. The autumn and first part of the winter 
was drier than usual, but not so much so as to 
produce a drought of any importance. The 
winter was a pleasant one, without any unusual 
physical occurrence to distinguish it from others 
in that climate. The tables subjoined to this 
chapter, exhibits more particularly, the tempera- 
ture and state of the atmosphere during this 
period. 

Early in the autumn of 1813, we began to re- 
ceive accounts of a destructive Epidemic in 
many towns not far distant. As the winter ad vane* 
ed, the accounts became more and more threat- 
ening, as the disease approached nearer to us. 



i>0 ORIGIN AND PROGRESS 

Tt was frequently fatal ; and the character which 
it acquired by report, did not diminish its terrors. 
The first case in Gardiner, to which I was called, 
was on the eleventh of February. The patient 
had been several days ill, but not so sick as to call 
a physician till this time. The case proved to be 
a severe one, but eventually terminated in re- 
covery. It was nearly a fortnight before any 
other cases of the fever occurred. Towards the 
last of February, however, several attacks fol- 
lowed each other in such quick succession, as to 
produce a considerable alarm. Some of these 
were in the family and immediate neighbourhood 
of the person first seized ; others were at a dis- 
tance, and had had no communication whatever 
with the sick. 

Throughout the month of March, the Epi- 
demic extended itself rapidly in all directions. 
In some of the families, where it first made its 
appearance, almost every person was seized by- 
it. In others, only one or two were at any time 
materially affected. In some cases, it seemed 
to spread progressively from house to house, 
as if communicated from one person to another; 
at the same time that in others, it suddenly made 
its appearance in distant neighbourhoods, seizing 
sometimes two or three persons in a family, nearly 
at once. All classes of people, and all ages 
seemed alike exposed to its attack. 



OF THE EPIDEMIC. 31 

Towards the end of this month, the Epidemic 
was more prevalent, than at any other period. 
Within a small circuit, more than fifty were con- 
fined with it at the same time. Many others, who 
were not reckoned among the sick, were slightly 
affected by similar complaints ; so that the sick 
and the invalids included a very large proportion 
of the population. Although the number of 
deaths was not large, yet the distress produced 
by the prevalence of sickness, was great. In 
many instances, the sick were but poorly suppli- 
ed with the accommodations and comforts, which 
such a situation requires. The distress arising 
from these circumstances, was much increased, by 
the difficulty and often the impossibility of obtain- 
ing suitable nurses. It was a disease which re- 
quired constant and unremitted care. But in such 
a town as Gardiner, where health generally pre- 
vails, there are but few, who are familiar with 
the course of attention and management which a 
sick person requires, and of these few, a large 
proportion were themselves sick. 

As I passed, with as much rapidity as possible? 
from one scene of wretchedness to another, my 
heart sickened at the sight of the sufferings 
which I was called to relieve, and at the pros- 
pect which they exhibited. The Epidemic, 
still extending itself in all directions, spread a 
gloom over the face of every object. Young 



Z4 OK1G1N A^D TKUGKEsS 

in the profession, and with but little experience, 
I was obliged to contend with a powerful dis- 
ease, in a situation where I could very rarely 
obtain the advantage of counsel. During the 
course of fatiguing practice, which this state of 
things required, I used no precautions to guard 
myself from an attack of the fever. I was con- 
stantly and laboriously engaged until late at night, 
and took my meals at irregular hours, as I could 
get an opportunity ; but without any injurious 
effects on my health. 

Early in the month of April, the progress of 
the Epidemic began to abate, and it continued 
to diminish throughout that month ; especially 
in the parts of the town in which it had previ- 
ously raged. About the 20th I was called to 
a considerable number of cases in Pittston, on 
the East side of the Kennebeck River ; as well 
as to several new cases in Gardiner. 

Throughout the month of May also, a consi- 
derable number of cases occurred. But they 
grew less and less frequent until the close of the 
month. The Epidemic may be said to have ter- 
minated its course in Gardiner with this month. 
In each of the three following months of June, 
July and August, I did not see more than two 
or three cases of Fever of any kind. 



of The epidemic. 33 

During the whole period of the Epidemic, 
sores of different kinds were unusually pre- 
valent, as well as for some time after its termina- 
tion. The most frequent of these was a spe- 
cies of boil, somewhat resembling a carbuncle, 
which was very common with the convalescent, 
as well as with those who had not been affected 
with general fever. It was a very painful tu- 
mour which in the course of two or three days 
from its commencement, ulcerated, and cast off 
a gangrenous slough. They were not often so 
severe as to require any other medical treat- 
ment than an emollient poultice, except when 
they were merely symptoms of a more impor- 
tant disease. The whitlow was also unusually 
prevalent at this time. Headachs and other 
slight symptoms of fever were almost univer- 
sal. Hardly a person could be found in the vil- 
lage of Gardiner, or its immediate vicinity, who 
had not, in the course of the three sickly months, 
been the subject of an affection more or less se- 
vere, which was similar in its character to the 
more important cases of fever. Most of these, 
perhaps, would hardly have been noticed at any 
other time. But they deserve to be mentioned 
as examples of the strong and universal tenden- 
cy to a particular disease, which prevailed at 
that period. 



34 ORIGIN AM) PROGRESS 

It was observable that the Epidemic through- 
out its whole course, was remarkably affected 
by the state of the weather, and especially by 
any sudden change in its temperature. This was 
true, not only in respect to the effect on indivi- 
dual cases, but also as applicable to the Epidemic, 
as such. A few days of unusual cold seemed to 
render all the existing cases more severe, and at 
the same time, produced a greater number of 
new attacks ; while on the contrary, a change 
from cold to milder weather produced a corres- 
ponding effect, in mitigating the symptoms and 
lessening the ravages of the disease. This was 
strikingly exemplified by the effect of the cold 
days from the twenty-first to the twenty-sixth of 
March, and of the warm days which followed. 
During these few cold days, the cases were much 
more frequent, and more severe than at any previ- 
ous time ; but as soon as the weather became 
mild, there was a remarkable mitigation of the 
symptoms, and diminution of the frequency of 
new attacks. Several of those to whom I was 
afterwards called, dated the commencement of 
their sickness from a period prior to the favora- 
ble change, in the temperature of the weather 
This effect seems to be attributable to the sud- 
den change, rather than to the coldness or warmth 
of the weather merely. For the fever general- 
ly was not more severe, nor more difficult to 
manage, in the early part of the season when the 
weather was cold, than it was at a later period, 



OF THE EPIDEMIC. 35 

when it was warmer. Nor on (he contrary did 
it increase in severity with the progress of the 
season. There was indeed very little difference 
in the facility of managing it, during all the time 
that it raged as an Epidemic, although some of 
the symptoms underwent considerable alteration. 

The following tables exhibit the rise and pro- 
gress of the Epidemic ; and in some measure the 
state of the weather at the time. T have begun 
them at a period considerably anterior to the 
commencement of the Epidemic, and continued 
them several months after its termination, in or- 
der that the reader may have as extensive a view- 
as possible, of every circumstance, in any degree 
connected with the subject The table of diseases 
does not exhibit those of any particular district, 
but those which came within my circuit of prac- 
tice ; which of course cannot be very accurately 
defined. Previously to the Epidemic, this circuit 
was very limited. In the course of the Epidemic 
it was very considerably extended ; so that the 
number of cases which the tables exhibit, towards 
the close of its ravages, bears a much smaller 
ratio to the amount of population among which 
it prevailed, than at an earlier period. After the 
termination of the Epidemic, the same paucity of 
diseases appears, as before its commencement ; al- 
though the sphere of my practice was as extensive 



.'*b ORIGIN AND PROGRESS 

as at any lime during its prevalence. The depart- 
ment of practice, which at Gardiner is the most im- 
portant to the physician, does not appear in the 
tables, because it is not usually reckoned among 
diseases. In a country so generally healthy as 
the District of Maine, and at the same time so 
fruitful, this department furnishes in ordinary 
times the most important, as well as the most pro- 
ductive part of the physician's labours. 

The thermometrical observations, though suf- 
ficiently accurate for a standard of comparison of 
one part of the season with another, are not to 
be considered as a conclusive evidence of the 
temperature of the climate. In making them, 
care was taken that the thermometer should be 
freely exposed to the air, in the shade ; but no 
attention was paid to the circumstances of ra- 
diation, or whatever else it is, that affects a ther- 
mometer, when exposed to a clear sky, on a 
widely extended, open area. The phenomena 
which such an exposure exhibits, had not excited 
attention, when these observations were made, 
and of course could not be taken into considera- 
tion, in selecting the place for the instrument 
used in making them. But this circumstance 
does not diminish their utility, for the purposes 
for which they are now published, however it 
might invalidate their authority, as data for inves- 
tigations upon climate. 



OF THE EPIDEMIC. 37 

The column in the tables for new attacks of 
fever is not quite complete, in consequence of 
my having sometimes omitted to notice in my 
minutes the time of attack. Notwithstanding this 
imperfection, the column may be of some use, to 
shew how far the progress of the disease was 
connected with changes of the weather. 



.38 



ORIGIN AND PROGRESS 



Meteorological and Pathological Table. 









DECEMBER, 1813 






Thermometer 






* * i 


Faces of the Sky. 


New Cases. 


D o7 


< & pi 






Observation. 


CO ^ Q, 






Wednesday 1 36 45 40 Cloudy, Rain. 




Thursday 2 34 36 25 Cloudy. 




Friday 3 16 2315 Fair. 




Saturday 4 


123121 


Fair. 




Sunday 5 


21i41 25 


Clear. 




Monday 6 


27 


3431 


Cloudy. 




Tuesday 7 


34 


38|31 


Rain, Fair. 




Wednesday 8 


33 


40 


33 


Cloudy, Snow. 




Thursday 9 


34 


35 


30 


Snow, Fair. 


Amenorrhea 1. 


Friday 10 


25 


33 


22 


Fair. 




Saturday 1 1 


20 


32 


20 


Fair. 




Sunday 12 


22 


26 


18 


Fair. 




Monday 13 


21 


31 


27 


Fair. 




Tuesday 14 


26 


38 


26 


Fair. 


Dentition 1. 


Wednesday 15 


22 


33 


">4 


Fair. 


Dent. 1. Fever 1 


Thursday 16 


14 


34 


28 


Fair. 




Friday 17 


— 


39 


.30 


Cloudy. 




Saturday 18 


28 


31 


31 


Snow, Fair. 




Sunday 19 


34 34 


23 


Fair. 




Monday 20 


1824 


17 


Cloudy. 




Tuesday 21 


612 





Fair. 




Wednesday 22 


927 


24 


Fair. 




Thursday 23 1938 


20 


Fair, Cloudy. 




Friday 24 3124 


4 


Fair. 




Saturday 25 -3 12 


6 


Fair. 




Sunday 26 18 5 Fair. 




Monday 27 


-6 17 14 Fair, Cloudy. 




Tuesday 28 


22 


30 


26 


Cloudy. 


Violent Anger 1. 


Wednesday 29 


28 


30 


29 


Snow. 




Thursday 30 


32 


30 


17 


! Cloudy, Fair. 




Friday 31 


15 


18 


10 Fair, i 




Means 


2] 


30 


22 







OF THE EPIDEMIC. 



39 



Meteorological and Pathological Table. 

JANUARY, 1814. 



Day, 

Observation. 

Saturday 
Sunday 
Monday 
Tuesday 



Wednesday 

Thursday 

Friday 

Saturday 8 

Sunday 9 

Monday 10 

Tuesday 1 1 

Wednesday 12 

Thursday 13 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 19 

Thursday 20 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 26 

Thursday 27 

Friday 

Saturday 

Sunday 

Monday 

Means 



Thermometer 



Faces of the Sky. 



New Cases. 



12 


30 


221 


15 


34 


26 


- 3 


4 


- 9 


-20 


10 


- 1 


_ o 


12 


-10 


-16 


15 


12 


16 


36 


28 


13 


23 





- 8 


30 


8 





23 


16 


19 


32 


30 


30 


36 


28 


20 


30 


14 


- 3 


29 


12 


2 


30 


24 


26 


30 


25 


30 


30 


26 


12 


34 


16 


26 


31 


25 


22 


27 


18 





27 


12 


- 6 


14 


4 





14 


15 


23 


29 


33 


24 


45 


20 


26 


33 


24 


10 


32 


24 


12 


39 


29 


o 


22 


- 1 


p 


34 


16 


- P 


'0 


-12 


9 


27 


14 



Cloudy, Fair. 

Fair. 
Fair and Calm. 

Fair. 

Fair. 
Fair, Cloudy. 
Cloudy, Fair. 

Fair. 

Fair. 

Fair. 

Fair, Cloudy. 

Cloudy. 

Fair. 

Fair. 
Fair, Cloudy. 

Snow. 

Snow, Fair. 

Cloudy, Fair 

Slight Snow. 

Fair. 

Fair. 

Fair. 
Snow, Cloudy. 
Snow, Rain. 

Fair. 
Fair, Cloudy. 

Fair. 

Fair. 
Cloudy, Fair. 
Snow, Fair. 

Fair. 



Rheumatism 1 



Pneumonia 1 



Abortion 1. 
Typhu3 Fever 3. 



Hysteria 1. 
Abscesses 1. 



Typhus Fever 1 



* These cases of fever were all in one family, in Pittston, seve- 
ral miles from where the Epidemic afterwards commenced ; and 
w«re of a character very different from it 



40 



ORIGIN AND PROGRESS 



Meteorological and Pathological Table. 

FEBRUARY, 1314. 



Days 

of 
Observation. 



Tuesday 

Wednesday 

Thursday 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 16 

Thursday 17 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 23 

Thursday 24 

Friday 

Saturday 

Sunday 

Monday 

Means 



S * 



Faces of the Sky. 



. 














fe 




|X| 






■fc 






1 


3 

3 




c; 


£ 










< 


a 



Other Diseases. 



-19 


12 


16 


23 


41 


35 


22 


40 


12 


-17 


8 


-16 


■26 


23 


- 7 


10 


26 


14 


- 3 


30 


25 


32 


35 


14 


6 


8 


12 


12 


18 


18 


26 


36 


33 


22 


24 


18 


20 


36 


27 


12 


36 


23 


23 


41 


28 


19 


46 


30 


36 


41 


42 


37 


49 


37 


32 


53 


32 


32 


40 


37 


27 


39 


21 


17 


33 


26 


24 


43 


36 


30 


40 


46 


40 


34 


25 


18 


32 


18 


12 


36 


32 


33 


37 


23 


18 


3-1 


1 23 



Fair, Snow. 

Mist, Fair. 

Cloudy, Fair. 

Fair. 

Fair. 

Cloudy, Fair. 

Fair, Snow. 

Fair & Windy. 

Hazy, Snow 

Cloudy, Hail. 

Cloudy, Rain. 

Fair <fc Windy. 

Fair. 

Fair, Cloudy. 

Hazy, Cloudy. 

Fair, Snow. 

Rain, Cloudy. 

Fair. - 

Fair. 

Cloudy. 

Fair. 

Cloudy, Fair. 

Fair. 

Cloudy, Rain. 

Fair. 

Fair. 

Fair, Snow. 

Snow, Fair. 



Typ. Fev. 2.* 
Colic 1. 



Catarrh 1. 



Cholera 1 



Catarrh 1 

Dent. 1, 
Wound 1. 



I Dis. of the 
► Heart 1. 
Worms I. 



* These two cases were in the same family, and of the same 
character, as those mentioned in the preceding page. 



OF THE EPIDEMIC. 



41 



Meteorological and Pathological Table. 

MARCH, 1814. 



' 


Thermometer 




> 
i2 


> 

3 




Days 


Sj s ] 4 


Paces of the Sky. 


c 


l 


Other Diseases. 


of 


< Ph a; : 


g 


1 




Observation. 


t- "3 o> 


< 


z 




Tuesday 1 


20 


26 25, Snow. 


2 




Wednesday 2 


22 


36 18| Fair. 




2 




Thursday 3 


16 


31 


191 Cloudy, Snotv. 


1 






Friday 4 


10 


16 


61 Fair. 




1 


Colic 1 . 


Saturday 5 


-;0 


18 


6 Fair. 


1 




Worms 1. 


Sunday 6 


- 9 


29 


13 


Fair. 






^ 


Monday • 7 


21 


35 


17 


Cloudy, Fair. 




2 




Tuesday 8 


12 


37 


34 


Fair, Cloudy. 


I 






Wednesday 9 


24 


46 


36 


Fair, Cloudy. 




1 




Thursday 10 


32 


37 


30 


Cloudy, Snow. 








Friday 1 1 


21 


: J -9 


3'? 


Pair, Cloudy. 








Saturday 12 


23 


jlO 


28 


Fair. 


1 






Sunday 13 


22 


25 


14 


Fair. 






Cephalgia t, 


Monday 14 


10 


34 


18 


Fair. 


4 


2 




Tuesday 15 


23 


10 


38 


Snow, Rain. 


1 


1 




Wednesday 16 


38 


37 


24 


Fair. 


2 






Thursday 17 


30 


34 


30 


Fair. 


1 






Friday 18 


3' 


49 


30 


Fair. 


1 


2 




Saturday 19 


33 


45 


25 


Fair. 








Sunday 20 


o. 
6 I 


32 


21 


Cloudy, Sriow. 


1 






Monday 2 J 


18 


40 


24 


Fair, Cloudy. 


5 


3 




Tuesday 22 


12 


30 


15 


Snow, Fair 


2 


3 




Wednesday 23 


i'e 


3d 


20 


Cloudy, Fair. 


2 


3 




Thursday 24 


12 


32 





Fair. 


-i 


2 




Friday 25 


16 


31 


26 


Cloudy, Fair. 


ii 


7 




Saturday 26 


13 


38 


38 


Fair. 




SO 




Sunday 27 


37 58 


1 


Fair. 


i 


4 


Dentition 1 


Monday 28 


34 


49 


35 


Fair. 


2 


3 




Tuesday 29 


26 


50 


82 


Fair. 


2 


2 




Wednesday 30 


34 


57 


-'4 


Fair. 


4 


2 




Thursday 31 


38 


■ 


;<-; 


Cloudy. 


4 


2 




Means 


21 


Jl 


20 











a 



ORIGIN AND PROGRESS 



Meteorological and Pathological Table, 

APRIL, 1814. 



Days 

of 
Observation. 



Thermometer 


S 


$ 


£ 


< 


(C 


0. 



Faces of the Sky. 



i I 

* c 

O £ 

2 "3 

1 I 



Friday 
Saturday 
Sunday 
Monday 
Tuesday 
Wednesday 6 
7 
8 
9 
10 
11 
12 



Thursday 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 13 

'Thursday 14 

Friday 15 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 20 

Thursday 21 

Friday 22 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 27 

Thursday 28 

Friday 29 

Saturday 30 

Means 



44 
30 
35 
49 
36 
36 
31 
37 
JO 

4: 
3: 
33 
3. 
30 
3 ';■ 
38 
30 
40 
3; 
41 



43 41 
51 38 
62 36 



10 39 

i9 42 

30 38 

46 33! 



4(1 


19 


24 


5 






4; 


•?•_■ 


5;' 


_. 


4 c 




3' 




:■ 




3 ; J 


aO 



44 44 

47 39 
hi 34 
50 36 
46 41 

42 38 

48 34 

57 46 
— 38 
46 40 

43 37 
14 39 

58 48 
34 
30 
42 
73 
58 
J r 
44 
58 



Cloudy, Rain.' 

F*air. 

Fair. 

Cloudy. 

Rain, Fair. 

Fair. 

Cloudy, 

Fair, Cloudy. 

Fair, Cloudy. 

Cloudy, Rain. 

Fair. 

Fair. 

Fair. 

Cloudy, Fair. 

Rain. 

Cloudy, Fair. 

Fair. 

Fair. 

Cloudy. 

Fair. 

Cloudy. 

Cloudy. 

Fair. 

Fair. 

Fair, Cloudy. 

Cloudy, Fair. 

Fair. 

Fair. 

Fair. 

Rain. 



1 


3 


2 


1 


} 


2 


] 


5 


2 


1 




1 


2 


1 


1 


1 




2 


2 


1 




1 


1 




1 


I 


i 


2 


1 


1 


3 


2 


4 


1 


3 


1 


2 


3 


1 


4 




2 


2 


1 




1 


1 


1 


1 






1 


2 




2 


o 



Other Diseases. 



Dentition 1 



Worms I 



OF THE EPIDEMIC. 



43 



Meteorological and Pathological Table. 



MAY, 1814. 





Thermometer 


1 £ 




Days 


ifl s" 


H 


Faces of the Sky. jg j ^ 


Other Diseases, 


< Oh* 


fc 


1 ' I 




Observation. 


O IH 


o> 


< is 




Sunday 1 


50 58 


44 


Fair. 


1. 1 




Monday 2 


40 


^4 


41 


Fair. 


2 2 




Tuesday 3 


38 


37 


3t- 


Cloudy, Thud'r. 


2 




Wednesday 4 


' 34 


48 


44 


Cloudy. 


2 1 




Thursday 5 


44 


51 


5 b 


Cloudy. 


1 2 




Friday 6 


38 


51 


48 


Cloudy. 






Saturday 7 


46 


42 


40 


Cloudy, Rain. 






Sunday 8 


42 


56 


47 


Cloudy, Fair. 


1 




Monday 9 


47 


58 


43 


Fair. 


1 




Tuesday 10 


44 


70 


46 


Fair. 


1 1 




Wednesday 1 1 


54 


60 


56 


Cloudy, Rain. 






Thursday 12 


55 


62 


54 


Cloudy. 






Friday 1 3 


56 


64 


58 


Cloudy, Rain. 






Saturday 14 


55 


53 


49 


Rain. 






Sunday 15 


48 


50 


50 


Rain. 




Deutition 1. 


Monday 16 


51 


62 


53 


Rain. 


1 2 




Tuesday 17 


52 


60 


56 


Cloudy. 






Wednesday 1 8 


60 


69 


52 


Cloudy, Fair. 


1 


Catarrh 1 . 


Thursday 19 


55 


76 


55 


Fair. 


1 




Friday 20 


52 


75 


56 


Fair. 


2 




Saturday 21 


£8 


58 


60 


Cloudy. 


1 




Sunday 22 


57 


70 


54 


Rain. 


1 




Monday 23 


55 


64 


56 


Fair. 






Tuesday 24 


50 


68 


55 


Fair. 






Wednesday 25 


50 


80 


62 


Fair. 






Thursday 26 


64 


84 


66 


Fair. 






Friday 27 


60 


78 


60 


Fair. 






Saturday 28 


58 


60 


56 


Rain. 


1 




Sunday 29 


54 


62 


57 


Cloudy, Rain. 


1 




Monday 30 


54 


55 


52 


Rain. 






Tuesday 31 


51 


54 


52 


Rain. 






Means 


Tl 


61 


52 




• 





44 



ORIGIN AND PROGRESS 



Meteorological and Pathological Table. 











JUNE. 1814. 








Thermometer 




Davs 

of 


A. M. 
P- M. 
P. M. 


Faces of the Sky. 


New Cases. 


Observation. 


<o rt 


o> 






Weduesday 1 52 66 54 Fair. 




Thursday 2 53 63 54 Fair. 




Friday 3 53 64 56 Cloudy, Fair. 




Saturday 4 


154 67 54 


Cloudy, Fair. 




Sunday 5 


56 65 50 


Cloudy, Fair. 




Monday 6 


47 64 


46 


Fair. 




Tuesday 7 


44 65 


50 


Fair. 




Wednesday 8 


47 


70 


51 


Fair. 


Dentition 1, Fever 1. 


Thursday 9 


53 


70 


55 


Fair. 


Fever 1. 


Friday 10 


57 


72 


55 


Fair. 




Saturday 1 1 


55 


74 


51 


Fair. 




Sunday 12 


58 


82 


62 


Fair. 




Monday 13 


60 


70 


— 


Fair, Rain. 




Tuesday 14 


— 


L_ 


— 






Wednesday 15 


— 


80 


— 






Thursday 16 


62 


83 


G5 






Friday 1 7 


60 


62 


— 






Saturday 18 


62 


15 


— 






Sunday 19 


— 


— 


— 






Monday 20 


— 




— 






Tuesday 21 


— 




— 






Wednesday 22 


52 


78 60 






Thursday 23 68 







Fever I. 


Friday 24 — 







Pneumonia 1. 


Saturday 25 — 






Sunday 26 51 68 62 


Fair. 




Monday 27 


62 — 66 


Fair, Rain. 


Rheumatism I 


Tuesday 28 


63 


66 64 


Cloudy, Rain. 




Wednesday 29 


59 


76 70 


Fair. 




Thursday 30 


50 


82 62 


Fair. 




Means 


SO 


nu 


33 







OF THE EPIDEMIC. 



45 



Meteorological and Pathological Table. 

JULY, 1814. 





Thermometer 






Observation. 


S I 'M 


Faces of the Sky. 


New Cases. 


< k * ■ 

•O fH O) 




Friday. 1 


58 84 


66 Fair. 


Fever 1. 


Saturday 2 


58 


83 


60, Fair. 




Sunday 3 


60 


78 


60 


Fair, Rain. 




Monday 4 


62 


80 


70 


Fair. 




Tuesday 5 


66 


70 


60 


Fair. 




Wednesday 6 


60 


68 


57 


Fair, Cloudy. 




Thursday 7 


58 


70 


54 


Fair. 




Friday * 8 


52 


76 


56 


Fair. 




Saturday 9 


54 


82 


54 


Fair. 




Sunday 10 


56 


78 


60 


Fair. 




Monday 1 1 


60 


60 


59 


Rain. 




Tuesday 12 


58 


68 


48 


Fair. 




Wednesday 13 


49 


70 


61 


Fair. 




Thursday 14 


59 


76 


70 


Fair, Shower. 




Friday 15 


62 


84 


71 


Fair. 




Saturday 16 


63 


92 


70 


Fair. 




Sunday 1 7 


68 


82 


65 


Cloudy, Rain. 




Monday 18 


65 


75 


68 


Fair. 




Tuesday 19 


51? 


_L 


60 


Fair. 




Wednesday 20 


52 


81 


58 


Fair. 




Thursday 21 


56 


64 


59 


Cloudy. 




Friday 22 


60 


68 


64 


Cloudy, Fair. 




Saturday 23 


58 


82 


64 


Fair. 




Sunday 24 


62 


82 


66 


Fair. 


Dentition h 


Monday 25 


64 


76 


64 


Fair, Shower. 




Tuesday 26 


56 


— 


62 Fair. 




Wednesday 27 


59 


80 


65 1 Fair. 


Bowel Complaints I 


Thursday 28 


61 


70 


70 


Cloudy, Rain. 




Friday 29 


67 


67 


65 


Rain, Fair. 




Saturday 30 


60 


80 


62 


Fair. 




Sunday 31 


<v I 


88 


70 


Fair, Shower. 




Means 


59 


76 


62 


1 





& A 



46 



ORIGIN AND PROGRESS 



Meteorological and Pathological Table. 

AUGUST, 1814. 



Observation. 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 10 

Thursday 11 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 1 7 

Thursday 18 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 24 

Thursday 25 

Friday 

Saturday 

Sunday 

Monday 

Tuesday 

Wednesday 31 

Means 



19 
20 
21 
22 
23 



26 
27 
28 
29 
30 




New Cases. 



b< 

60 
58 
60 
55 

5b 
62 

66 

6 

60 

56 
64 
62 
63 
56 
56 
64 
56 
58 
56 
56 
49 
43 



)|62 
58 
62 
61 
59 
64 
70 
65 
65 
71 
64 
72 
68 
64 
56 
70 



66 



56 
59 
40 
49 
50 
54 
56 
60 



57 74'bl 



Fair, Rain. 
Cloudy, Rain. 

Fair. 

Cloudy, Rain. 

Fair. 

Fair. 

Fair, Cloudy. 

Cloudy, Rain. 

Rain, Cloudy 

Fair. 

Fair. 

Fair, Shower. 

Fair, Shower. 

Fair. 

Cloudy, Rain 

Cloudy, Fair. 

Fair, Cloudy. 

Fair. 

Fair. 

Fair. 

Fair. 

Fair. 

Fair. 

Fair, Rain. 

Fair. 

Fair. 

Fair. 

Rain. 

Cloudy, Fair 

Fair. 
Rain, Fair. 



Pleuritis. 1. 



8owel Complaints 1. 



Bowel Complaints 1, 
Fever 1. 



Dysentery 2. 



OF THE EPIDEMIC. 47 

These Tables, it is to be observed, contain 
only those cases of disease, which were suf- 
ficiently severe to induce the patient to call 
me to his house. The multitude of slight cases, 
which occurred, especially during the prevalence 
of the Epidemic, for which applications were 
made and medicine sent, without my visiting 
them, are not noticed. It has been my object to 
exhibit in them, as fair a view as possible, of the 
great difference in the prevalence of sickness, 
during the Epidemic, and at other times. 



CHAPTER II< 



DESCRIPTION AND SYMPTOMS OF THE FEVER. 

There is a considerable degree of difficulty in 
distinctly characterizing a disease, so multifarious 
in its appearances, as this under consideration. 
At different periods of its progress, and in dif- 
ferent cases, it assumed a great variety of symp- 
toms, which in many instances seemed opposite 
to, and inconsistent with each other ; and which 
were continually changing their nature. Yet 
there were certain general features which were 
sufficiently constant, and universal, to give a 
character to the whole. It was a disease which 
could hardly be mistaken in practice, but which it is 
extremely difficult to characterize in description. 

The most striking appearance which it ever as- 
sumed, was the great depression of the vital powers. 
The debility was extreme ; the patient faint and 
helpless, was unwilling, or unable to make the least 
exertion ; the pulse low and generally quick ; al- 
most sunk from the touch of the linger ; the skin 
dry and mealy, though sometimes with a burn- 

7 



50 DESCRIPTION AND SYMPTOMS 

ing lieat, generally inclining to be cold, had a life- 
less, puffy, non elastic, half cedematous feeling; 
the countenance somewhat bloated, was void of 
expression, fixed and inanimate, as if the spark 
which once lighted it, had already expired. The 
tongue dry, coated and dark coloured, was often 
protruded with difficulty ; the stomach faint and 
exhausted by frequent vomiting ; the head affected 
with pain and dizziness, sometimes amounting to 
delirium ; the extremities cold and insensible, and 
affected with irregular paroxysms of pain; in 
short, the whole system was almost overpowered 
by the weight of disease ; which, however, shewed 
itself more by negative than by positive symptoms. 

Such are some of the general features of this 
disease. But in order to form a correct estimate 
of its character, it is necessary to take a nearer 
view of it, and to examine the symptoms as con- 
nected with each other, in the different stages of 
its progress. For this purpose I shall consider it 
as divided into four periods, or stages ; the access, 
the vomiting stage, the comatose stage, and the con- 
valescence. These distinctions will, I think, be 
found sufficiently accurate for the purposes of 
description ; although it is not by any means 
pretended, that they were clearly presented in 
every case that occured. A disease, whose ir- 
regularity of appearance might almost be reck- 
oned a characteristic, cannot be arbitrarily sub- 
jected to fixed rules. Yet the division, without 



OF THE FEVER. 51 

any attempt to adhere very rigidly to it, will aid 
in conveying a -correct knowledge of the true 
character of the disease, and in estimating the im- 
portance of the different symptoms. 



THE ACCESS. 

The disease was exceedingly various, in different 
cases, in its mode of attack, both in respect to the 
suddenness of its approach, and to the symptoms 
with which it commenced. In some persons, the 
transition from health to severe sickness, was 
abrupt and violent, only a few hours, or sometimes 
only a few minutes, intervening between them. In 
others, though much more rarely, it was slow and 
gradual, and occupied several days. Nor have I 
been able to discover that any peculiar age, or 
condition, or habit of body, had any consider- 
able influence, in rendering patients more or less 
susceptible of a violent attack. The old as well 
as the young, the feeble as well as the vigorous, 
were seized in the most violent manner; while in 
other instances, the robust and invalids were alike 
gradually assailed. 

Thus for example, a vigorous man of thirty- 
three, who bad left his house after breakfast in the 
morning, and gone to his work, returned in a short 
time so ill, as to reach home with difficulty, 
and before noon was in a delirium. A gentle- 



52 DESCRIPTION AND SYMPTOMS 

man of eighty was seized in the morning, while 
sitting in his chair, with such violence as to be un- 
able to reach his bed without assistance. A 
healthy boy of four years, was attacked about four 
o'clock in the afternoon, and became delirious with- 
in an hour. A young woman of rather a feeble 
habit, but who had been at work most of the day, 
and had been out in the afternoon, without being 
conscious of any illness, was attacked while at 
supper, in a manner which seemed to threaten im- 
mediate death. A woman rather more than eighty 
years of age, was taken suddenly ill at night, with- 
out any previons indisposition. 

A neighbour of the man first mentioned, of 
about the same age, possessing an equally good 
constitution and health, and engaged in the same 
business, grew gradually ill for a week, before he 
was necessitated to call in the aid of a physician. 
An aged woman between sixty and seventy, suf- 
fered the slow approach of the fever, four or five 
days, before she consulted me, although I was in 
the house every day, attending others in the family. 
Neither of these two last mentioned cases, how- 
ever, proved to be severe. A young married 
woman, previously of good health, became gra- 
dually ill four days before she called a physi- 
cian, and was then very sick, and recovered with 
great difficulty. Another married woman of 
about the same age, and of a remarkably vigorous 



OF THE FEVER. 53 

constitution, was growing ill a week before she 
took medicine, was very sick a few days, and re- 
covered in a short time. 

Some of these cases will be noticed more par- 
ticularly hereafter. They are introduced here to 
shew with what different degrees of severity, per- 
sons in various situations of life, and various states 
of health, were attacked. Although every species 
of constitution seemed liable to every variety in 
the manner of attack ; yet it may be observed, that 
of those, to whom the fever made a gradual ap- 
proach, there was a larger proportion, who had 
previously been feeble and debilitated, than vigor- 
ous and robust. It was perhaps, partly in conse- 
quence of this, that it was frequently remarked, that 
those who were slowly assailed in this manner, were 
often longer in recovering than others who had 
been more violently seized. Another reason was, 
that in consequence of the delay in applying to a 
physician in the former case, the disease had more 
opportunity to fix itself, before an attempt was 
made to eradicate it. It not unfrequently hap- 
pened, that a person after having been seized with 
the fever, was partially relieved by some domestic 
remedy, and neglected to apply for medical aid, 
until a return of severe symptoms These cases 
were more difficult to manage, than those to which 
I was called on the first attack. 



04 



DESCRIPTION AND SYMPTOM & 



The most common mode of attack was, by a 
violent pain in the head and dizziness, which were 
soon followed by a pain in the back ; pain in the 
limbs, sometimes fixed, but oftener darting in 
severe paroxysms from one part of the body to 
another ; nausea and vomiting ; great thirst ; 
chilliness, succeeded by heat, and a general feel- 
ing of distress not referred to any particular part. 
The skin was always dry and parched, with a 
mealy and commonly a burning feeling ; the 
tongue dry, and soon covered with a thick coat; 
the countenance fixed and dejected ; the pulse 
quick and commonly feeble from the first ; the 
limbs often cold and numb. 

Not unfrequently a person was suddenly seized 
witli most or all of these symptoms together, 
while engaged in his ordinary occupations, or sit- 
ting at his meals, or in bed. In other cases he 
had been subject to a slight head-ach and dizzi- 
ness, or dizziness without pain, for several days, 
when the more violent attack commenced. Some- 
times the pain commenced in some one of the ex- 
tremities, and extended up into the trunk and 
head, when the other symptoms immediately 
followed. In a few instances pain in the bowels 
and diarrhoea, were the first symptoms which 
made their appearance. 



OF THE FEVER. 55 

In the earlier part of the epidemic period, the 
disease always commenced with severe pain in 
some part of the body, which, if it did not begin 
there, soon extended to the head and back ; and 
in a few cases the pain increased, till in a short 
time it produced a delirium. Later in the season, 
however, pain was a less constant symptom. The 
disease then frequently commenced with a feel- 
ing of extreme faintness, or severe distress in the 
region of the stomach, or by general distress 
without reference to any particular part of the 
body. Sometimes in females, violent symptoms 
of hysteria ushered in an attack of fever. Where 
the approach of the disease had been gradual, in 
a few instances the patient complained of very 
little positive suffering, but rather of a general 
languor and debility, and loss of appetite, with a 
slight degree of thirst and occasional dizziness. 

The pain in the back and limbs, particularly 
the latter, occasionally renewed their attacks 
throughout the whole course of the disease ; and 
were not unfrequently so severe as to assume 
something of the appearance of rheumatism. It 
was, however, easily removed by the application 
of remedies, although very liable to return. 

Besides the varieties of pain, which I have 
mentioned, there was in several cases, during the 
first day or two, an acute pain in the chest, ac~ 



<Jb DESCRIPTION AND SYMPTOMS 

companied by a cough and expectoralion of thick 
mucus often streaked with blood. Early in the 
season this symptom was pretty common ; but 
afterwards it seldom appeared. The cough and 
expectoration were considerably common in cases 
where there was no pain in the thorax. They 
were not often very troublesome, as the cough 
was generally moist and the expectoration easy. 

Nausea and vomiting were nearly universal at 
the commencement of the fever, in every stage of 
the progress of the Epidemic. Unless in cases 
where there had been previous symptoms of a 
derangement of the functions of the stomach, the 
matter thrown up by the vomiting, consisted 
merely of watery fluid, intermixed with the sub- 
stances which had been taken into it, immediately 
preceding and after the attack. The bowels, ex- 
cept in a very few cases of diarrhoea, exhibited no 
considerable marks of disorder at the beginning, 
nor at any subsequent period of the disease. 
They were indeed rather inclined to costiveness ; 
but this was apparently the effect of the opium 
administered. The alvine evacuations generally 
preserved their healthy appearance, to a remark- 
able degree. 

The thirst was extremely urgent, and rathei 
peculiar in its nature. It was not the desire for 
cool or acid drinks, commonly witnessed in fevers. 



OF THE FEVER. 



57 



Except in a very few instances, these were dis- 
agreeable, and those which were warm and aro- 
matic demanded in their stead. Infusions of pep- 
permint, pennyroyal, or ground hemlock, were 
the most common drinks, and by far the most 
pleasant to much the greater part of patients. 
Their aromatic quality seemed to operate like a 
cordial, to remove the sensation of depression, 
which was constantly felt at the stomach/ 

I have mentioned chilliness and subsequent heat 
among the general symptoms of the commence- 
ment of this fever, although they were very far 
from being universal. In the first part of the 
season, they were common ; but at a later period, 
there was frequently rather a universal coldness 
and inaction, than a real chill ; and no heat fol- 
lowed, except as it was supplied by external 
means, and by rousing the system to action. 
Whenever this coldness appeared, it was always 
accompanied by numbness, and a feeling of dead- 
ly torpor, in the skin, which words cannot ade- 
quately describe. The countenance was ghastly, 
the face and hands livid, with livid spots occasion- 
ally upon other parts of the body ; and the whole 
system seemed rapidly sinking, as if into a state 
of putrefaction. 

The pulse was almost always quick in this 
stage of the disease, but exceedingly various in 



58 DESCRIPTION, AND SYMPTOMS 

its appearance in other respects. During the first 
part of the time, a considerable number of cases 
occurred in which it was rather full and hard, for 
the first few hours, sometimes for a day, and in 
two or three instances for a longer time. In by- 
far the greater number of cases, however, the 
pulse was extremely feeble from the very com- 
mencement of the sickness ; and in all, after a 
short time had elapsed. 

In order to illustrate more fully the various 
modes of attack, I shall here extract the first 
descriptions of several cases of different kinds, as 
I find them recorded in my note-book. This 
method will make some slight repetitions neces- 
sary hereafter ; but I think the disadvantage will 
be more than counterbalanced by the facility it 
will afford, of presenting a more precise and satis- 
factory view of this stage of the fever, than can 
be furnished by description alone. 

February 26. — J. D. a boy eleven years old, 
was suddenly seized yesterday morning, with a 
violent pain in the head and dizziness ; nausea and 
vomiting. During the night he was in a perfect 
delirium. This morning he is rational. The 
vomiting has ceased ; but the nausea continues, 
with a depressing feeling in the region of the 
stomach. He still complains of great pain in the 
head and dizziness, and pain in the back and 



OF THE FEVER. 



59 



limbs, some numbness of the extremities ; thirst, 
but desires only warm drinks. His pulse is quick 
and tolerably strong, and his tongue much coated. 
His bowels are not disordered. 

A. B. a young unmarried woman complains 
of pain in the head and dizziness ; constant vom- 
iting ; numbness of the extremities ; tongue coat- 
ed ; pulse not remarkably quick, though some- 
what hastened. She has been liable to similar 
complaints at her menstrual periods, of which the 
present time is one, but they have never before 
been so severe, nor attended with fever. 

S. L. a girl of about eighteen, began to be a little 
ill three days ago, after rincing clothes, in cold 
water, in the open air. In consequence of this, her 
menses which had just commenced were suppres- 
sed. She was not, however, so sick as to ask for 
advice till to-day, though I have been in the house 
daily attending her sister. She complains of 
pain in the head and dizziness, nausea, &c. ; but 
is able to sit up considerably. Her bowels are 
in good order, except that they are rather inclin- 
ed to costiveness. 

Mrs. H. a married woman about forty years 
old, has lately been considerably exhausted by 
attending upon a sick child. She was violently 
attacked to-day with severe pain in the head and 



60 DESCRIPTION AND SYMPTOMS 

dizziness ; pain in the back and limbs ; occasional 
vomiting ; tongue coated ; thirst for warm drink ; 
a severe acute pain in the thorax under the 
right breast, which occasions difficulty of breath- 
ing; a full, hard, quick pulse. She has been 
several days subject to a cough, attended by a 
free expectoration, both of which continue. 

M. W. is a vigorous young man about thirty. 
He has walked, or rather skated on the ice, two 
miles to-day to church, where he attended all 
day, and returned in the same manner. He be- 
gan to feel rather ill, before he reached home ; 
and soon after, was seized with extreme pain in 
the head and dizziness ; with pain in the back and 
limbs ; and rather a slight pain in the upper part 
of the thorax, nearly under the right clavicle ; ri- 
gors, followed by heat and thirst ; tongue dry ; 
pulse quick, full and hard. 

S. C. a boy four years old, about four o'clock 
this afternoon was suddenly seized while at play 
with violent pain in the head ; nausea and vomit- 
ing ; pain in the chest ; chills followed by heat, 
&c. In a short time delirium supervened, and 
continued a few hours. He was thirsty; tongue 
dry; pulse quick and hard. 

March 9. — S. B. a girl five years old, was seiz- 
ed this afternoon with pain in one cheek ; which 



OF THE FEVER. 61 

soon, however, left the cheek, when she complain- 
ed of her stomach, and of general distress. Vomit- 
ing soon gave her partial relief. She has head- 
ach and dizziness ; dry skin and tongue ; pulse 
quick and rather hard. • 

March 13.— M. B. an unmarried woman of 
about twenty-five, of generally good health. She 
has however, for a week or two past, been troubled 
with symptoms of indigestion, and with pain and 
soreness about the sternum, arising probably from 
the nature of her work, which has been picking 
large paper in a paper-mill. This morning she 
was seized with chilliness ; great pain in the head 
and dizziness ; nausea ; and a sense of general dis- 
tress which she was unable to describe ; thirst ; 
livid spots about her nails. I was called in the 
afternoon. Her tongue was dry and protruded 
with some difficulty ; skin dry ; pulse quick and 
feeble. It seemed full on a slight examination, 
but was very compressible under the finger ; ge- 
neral distress somewhat abated. 

March 16. — Mrs. L. a young married woman 
of good general health, was seized on the 12th, at 
Augusta, with the usual symptoms, pain in the 
head, dizziness, &c. She was brought home in a 
sleigh the 13th, but has had no physician till to- 
day. Her pulse is feeble and rather quick ; 
tongue coated and dry ; skin dry ; no constant se- 



62 DESCRIPTION AND SYMPTOMS 

vere pain ; much disposed to vomiting ; inclined to 
faintness ; has a dry, troublesome cough, without 
any expectoration. Her limbs are at times numb, 
slightly swelled and puffy. She is thirsty, with 
a strong desire for cider. 

March 17. — Mrs. W. a married woman about 
thirty, was taken in the night of the 14th with 
chills ; paifi in the head, &c. She has had no 
medical advice till this evening. She now com- 
plains of faintness and extreme dizziness, if she 
rises from a horizontal posture ; pain in the back 
and limbs; occasional numbness of the limbs, 
which have a very puffy feeling ; nausea and dis- 
tress at the stomach, with loss of appetite, but no 
vomiting; tongue coated and dry. Her skin is 
dry, but has been moist in the night at times ; 
she gets very little rest ; pulse feeble, of natural 
quickness ; bowels costive and sometimes painful ; 
tongue and jaws feel stiff. 

March 21. — H. M. a young unmarried woman, 
has this afternoon attended a funeral in usual 
health. About seven o'clock she sat down to 
supper with the family, though she felt not much 
appetite. She was suddenly seized, while at table, 
with extreme distress in the stomach and head, 
followed in a few minutes by delirium. When I 
arrived, which was in a very short time, she was 
cold, helpless, took no notice of surrounding ob- 



OF THE FEVER. 63 

jects ; did not answer when spoken to ; had fre- 
quent startings. Her respiration was laborious ; 
pulse very feeble and rather slow. 

N. W. a healthy man about thirty-five years 
old, was suddenly seized about an hour before 
sunset this afternoon, with extreme pain in the 
head and dizziness, and distress at the stomach, 
but no nausea or vomiting ; trembling, and a feel- 
ing of extreme debility. 

March 22. — C. G. a girl aged two years and 
eight months, generally healthy and vigorous, has 
been several days affected with a catarrh. About 
three o'clock yesterday afternoon, she was sud- 
denly seized with pain in the side and very great 
general distress, followed in a short time by vomi- 
ting; and thirst for cold water. She was put into 
bed, and measures taken by the family to pro- 
cure perspiration; but without success until some 
time in the night, when the skin became moist, 
and she was rather easier. To-day (when I have 
seen her for the first time) the skin continues 
moist ; she complains of no pain but in her head ; 
has vomited three or four times ; nausea constant ; 
takes warm drinks ; pulse somewhat quickened ; 
tongue natural ; continues to expectorate easily 
and freely. 



64 DESCRIPTION AND SYMPTOMS 

March 23. — Mr. L. aged fifty-seven, has been 
rather ill for several days, but has taken very little 
notice of his illness until yesterday about noon, 
when he was seized with pain in his arms, which 
soon went into his legs and back again to his arms 
alternately several times, during which time it 
commenced severely in his head, and in the 
thorax. He has been at times in a delirium, but 
slept considerably during the last night. I first 
saw him about noon to-day. His pains were re- 
lieved, except that in the thorax, by a diaphoresis, 
obtained by taking warm drinks, and by the exter- 
nal application of sudorifics. His tongue is much 
coated, but moist. He complains of a severe pain 
in the right side of the chest ; and at times of 
numbness in his limbs. His pulse is 110, and 
tolerably strong. 

March 25. — M. O. a girl aged ten years, was 
taken this morning. She first complained of 
pain in her feet and legs ; which were bathed in 
warm water, when the pain went into her ear ; and 
immediately after, the usual symptoms so often 
described appeared. 

March 26. — B. W. a girl eight or ten years old, 
was taken to-day, while returning from school 
about one o'clock, very suddenly and violently 
with pain in the bowels, to which the other symp- 
toms of the fever were soon added. 



OF THE FEVER. 65 

March 27. — H. 4. a girl twelve years old, was 
taken last evening with great general distress and 
violent delirium. 

H. G. a man about thirty-three years old, was 
taken ill yesterday with symptoms of fever, with- 
out much pain or distress. 

These cases sufficiently exemplify the great 
variety in the mode of attack of the fever under 
consideration, both as it respects the nature of the 
symptoms, and their peculiar combination in dif- 
ferent patients. This variety was very much in- 
creased, by the great difference in the length of 
time, during which the several symptoms con* 
tinued, before they yielded to others. How long 
they would have continued, or what changes they 
would have undergone, without the application 
of remedies, it is impossible to ascertain; for re- 
medies of some kind were generally applied early 
in the disease ; often before the arrival of a 
physician, and always immediately after. So far, 
however as it was in my power to observe, there 
was very little, if any, disposition to remit, 
in any of the more important symptoms. The 
patient always continued to grow worse, until 
something effectual was done for his relief. In 
many instances a diaphoresis obtained by the 
plentiful use of warm aromatic drinks and ex- 
ternal sudoritics, produced a very considerable 

9 



66 DESCRIPTION AND SYMPTOMS 

degree of relief; but in others, scarcely any mit- 
igation of suffering could be procured by these 
means; and in none, where the disease was at all 
severe, was there any thing like a complete cure 
effected by them. Either the same disagreeable 
symptoms returned after a short time, or others 
equally unpleasant took their place. 

But after the medicines were administered, 
which sooner or later were successful in remov- 
ing these painful symptoms, and arresting the pro- 
gress of the disease, there was a very great differ- 
ence in the length of time, requisite for them to 
accomplish this purpose ; even in cases which in 
other respects, did not seem very dissimilar. In 
many instances, in three or four hours after the 
exhibition of the appropriate remedies, a gentle 
diaphoresis came on, and most of the preceding 
symptoms, particularly those which were of a 
nature to cause much suffering, disappeared. In 
other cases, six, eight, ten, twelve, and in a few in- 
stances twenty-four hours or even more, passed 
away before this effect could be fully accomplish- 
ed. Sooner or later, however, the more violent 
of the symptoms, enumerated as constituting the 
first sta^e of the disease, were removed, and made 
to give place to others, which, though many times 
equally troublesome to the physician, were ge~ 
nerally much less painful to the patient. 



OF THE FEVER. 67 

THE SECOND OR VOMITING STAGE. 

Whatever may have been the manner in which 
the fever had commenced, as soon as the symp- 
toms, which I have considered as constituting the 
first stage, yielded to the operation of medicines, 
the disease assumed a much greater uniformity 
of appearance and character ; and exhibited a 
train of symptoms in many respects different from 
those which had preceded. The pain in the head 
was removed. The dizziness became much less 
troublesome, being felt only upon some sudden 
motion of the head, or upon raising it quickly from 
the pillow. In the place of these two symptoms, 
there was often a feeling of lightness about the 
head. The patient generally described it as feel- 
ing unusually large and empty ; and would some- 
times put up his hand, to ascertain whether he 
really had his own head upon his shoulders. This 
was not accompanied by any other symptom of 
delirium. For a complete delirium in this stage 
of the disease was an exceedingly rare occurrence. 
I saw only one or two instances of it, during the 
prevalence of the Epidemic. 

The pains in the back and limbs were relieved ; 
so far as they had been constant symptoms. Al- 
most all my patients were, however, subject dur- 
ing this stage to irregular fits of pain, in different 
parts of the body. The pain was often very 
severe while it continued, but was generally re- 
moved with ease. 



68 DESCRIPTION AND SYMPTOM* 

The appearance of the skin was very different 
in this, from what it had been in the preceding 
stage. It seemed to be in a great measure re- 
stored to its functions, which had been suspended. 
It was wa,rm, without that burning heat, which it 
before possessed, though still having much of the 
puffy feeling already described. It was moist, 
and rather inclined to profuse sweats. Indeed, it 
required a good deal of watchfulness to regulate 
properly the degree of moisture which served as a 
sort of index to direct the application of many of 
the remedies. After a diaphoresis was once pro- 
duced, if the measures which caused it were conti- 
nued with the same vigour, it soon ran into a pro- 
fuse sweat ; which not only greatly weakened the 
patient, but in a short time almost invariably led 
to a return of the dry skin and all its concomitant 
symptoms of pain, dizziness, &c. On the other 
hand, after the appearance of the diaphoresis, if 
the remedies which had procured it were entirely 
omitted, or negligently administered, the skin 
became dry, and the patient returned nearly to 
his former state . 

How far this diaphoresis was the result of the 
natural efforts of the disease, it is impossible to 
determine with accuracy ; because the disease was 
never left to itself a sufficient length of time, to 
ascertain what course it would take, if it had not 
been interrupted in its progress. One thing how- 



OF THE FEVEK. 69 

ever is certain, that in no case, within the circle 
of nay practice, did there any moisture appear on 
the skin, until after the application of remedies ; 
although in many instances, these were deferred 
to a later period of the disease, than that in which 
it appeared in other cases, where they had been 
early applied. 

The facility with which a diaphoresis was ex- 
cited, was exceedingly various in different cases. 
In some, not only a much longer time, but a much 
greater quantity of medicine was required than 
in others, apparently of nearly equal severity. 
With only one or two exceptions, however, this 
excretion was always produced, before the other 
symptoms were materially relieved ; and having 
once commenced, it could be sufficiently well ma- 
naged, if the attendants were careful in discharge 
ing their duty. Whenever a patient relapsed in- 
to his first symptoms of dry skin, &c. I invariably 
considered it the consequence of his own fault, 
or of those about him. I had one case in which 
I was never able to excite a perspiration, by any 
means, which I deemed it proper to use, until a 
late period of the convalescence. The patient, 
a boy about six years old, was subject during 
nearly the whole sickness to a diarrhoea, which 
seemed in some measure, to perform the same 
offices for him, as the perspiration did for others. 



70 DESCRIPTION AND SYMPTOMS 

At the commencement of this stage, the tongue 
was always dry, and covered with a thick coat, 
which at first was white, but soon became brown, 
and in many instances perfectly black. In the 
progress of this stage it generally, though not al- 
ways, became moist ; the moistness beginning at 
the edges and gradually extending over the whole 
surface of the tongue. The chilliness always dis- 
appeared as soon as the perspiration commenced, 
and never returned unless that was checked. 
The countenance was less expressive of anxiety 
and depression ; the limbs were still subject to 
occasional, but not to constant numbness; the 
pulse was generally quick and extremely feeble. 
During this stage, the deceptive appearance of 
the pulse already mentioned, occurred oftener than 
before. On a slight application of the finger, 
it frequently felt as full, or nearly so, as it com- 
monly is in health ; but if a little compression was 
made, the pulsations could hardly be distinguish- 
ed. This apparent fullness disappeared, if from 
any cause, the exhibition of tonic remedies was 
interrupted for a few hours, and the pulse became 
to the slightest examination, exceedingly small 
and weak. 

Soon after the moisture began to appear upon 
the skin, the nausea and vomiting were generally 
relieved, with the other symptoms of the first 
stage. But after a few hours, the vomiting recom- 



OF THE FLVLfi. i 1 

menced, though with appearances somewhat dif- 
ferent from those it had before. There ws~ 
continued nausea, and no painful retching. The 
stomach simply rejected the substances taken in- 
to it. It \va- not an attempt to throw off any of 
the fluids which had already become a part of the 
system, but to prevent the reception of any new- 
ones into it. The patient in most cases continued 
to take nourishment, and particularly drinks, with 
as much relish as ever : but after they bad been 
in the stomach a very short time, without any 
previous or subsequent nausea, he vomited and 
rejected them. The thirst which had nearly dis- 
appeared in the earlier part of this stage, now 
returned under a new form. It was now an ex- 
tremely urgent desire for cold water. But when- 
ever this desire was gratified, vomiting was occa- 
sioned immediately, the water was rejected, and 
the desire for it became greater than it had 
been before. This sort of perverted appetite 
was very greatly relieved, by allowing the pa- 
tient to rinse his mouth, and gargle his throat 
with cold water. When he was too youno, or 
had too little discretion to do this without swal- 
lowing the liquid, a bit of linen was sometimes 
wet with the water, and put into his mouth, 
which gave a partial relief. 

Although this peculiar species of vomiting wa* 
by no mean= universal in its appearance, in the 



72 DESCRIPTION AND SYMPTOMS 

different cases of the disease; yet it was more 
general than most of the other symptoms that 
occurred. There were indeed a considerable 
number, who though perhaps severely attacked, 
by the seasonable application of remedies had 
the disease entirely arrested in its progress, and 
passed at once from the access, to a state of ron- 
valeseenee and health. But where the disease 
continued more than a day or two, very few 
escaped this symptom. The vomiting showed 
no disposition to remit of itself. On the contrary, 
unless the most active measures were taken to 
subdue it, it grew more and more obstinate, as 
the patient deci eased in strength. It was at this 
time that the sensation of extreme faintness and 
sinking, which was always referred to the region 
of the stomach, was the most urgently felt. Many 
of my patients more forcibly than elegantly de- 
scribed it, by calling it a gone feeling. 

This disposition to vomiting was sometimes 
subdued in two or three hours. It oftener lasted 
six or eight hours ; and in some cases it continu- 
ed, with only short intervals of abatement, for 
two or three days. In any case, it always mani- 
fested great readiness to return, upon the slight- 
est imprudence, either in diet or management. 
Vomiting was often excited, after it had ceased 
several hours, by the patient's suddenly raising 
himself up, or by his taking a little too much 



OF THE FEVER. 73 

liquid into his stomach at once. We were able 
however, by cautious management, to preserve 
his strength from entirely failing, and after a 
longer or shorter time to subdue the vomiting 
entirely. 

THE COMATOSE STAGE. 

Soon after the vomiting had ceased, the patient 
generally sunk into a quiet sleep. From this 
sleep, he was easily awaked by the attendants, 
though he rarely awoke of himself, and when 
roused he soon slept again. In most cases, it seem- 
ed to be the natural result of his previous dis- 
tress, exhaustion, and watchfulness ; which as 
their causes were now removed, yielded to the 
grand restorer of nature. The pain was entirely 
gone, and the dizziness mostly so — the breathing 
perfectly easy — the tongue commonly inclined 
to moistness, though of a dark color and in many 
cases black — skin moist, inclining to a profuse 
sweat — the pulse generally fuller than before, at 
least apparently so, and often slower. The pa- 
tient in most cases, now took his medicines with- 
out the slightest difficulty, and often took some 
species of food with relish. In short, he felt him- 
self relieved from his greatest sufferings, and 
indulged a sanguine hope of a speedy recovery. 

10 



74 DESCRIPTION AND SYMPTOMS 

But these symptoms were often the deceitful 
precursors of a more dangerous state, than any 
we have yet met with. In a short time, especially 
if Ihe attendants had not been extremely diligent 
in their care of the patient, his respiration became 
deeper and slower, and soon after stertorous, — 
he was roused with difficulty, and could be made 
but imperfectly to comprehend what was said to 
him. From this cause he answered incoherently, 
and often fell back into a deep sleep, as the an- 
swer died away upon his lips. Sometimes the 
efforts which were made to rouse him, would ex- 
cite a momentary appearance of anger, which how- 
ever was immediately after, drowned in his return- 
ing drowsiness. He would for some time readily 
swallow whatever was put into his mouth, if sen- 
sible enough to know that it was there. His head 
became hot, and his face swelled, and of a deep 
crimson and almost purple colour. His eyes, if 
he was roused enough to open them, gave but a 
vacant stare, without apparently recognizing any 
object. The whole body was covered with a 
profuse sweat, — the extremities grew cold and 
insensible ; the pulse became still slower and 
often intermitted, although it still generally 
felt under a slight pressure, as if full and strong.. 

Even now the case was not hopeless, when we 
could depend upon the assiduous care of all the 
attendants. I have repeatedly seen patients re- 



OF THE FEVER. 75 

cover from this complication of threatening symp- 
toms. But unless the most vigorous and persever- 
ing exertions were made, the breathing became 
rapidly more and more stertorous, and at the 
same time laborious. The coma became so deep, 
that the patient could not be roused from it. The 
muscles of deglutition being no longer excited 
by the fluids put into his mouth, however stimu- 
lant in their nature, they were suffered to remain 
there, or more often they were forcibly ejected 
upon the clothes and into the faces of the atten- 
dants.^ The colour of the face assumed a deeper 
and almost livid hue, and livid spots appeared on 
various other parts of the body. The coldness 
of the extremities extended itself more and more 
over the surface of the body. Suddenly the 
pulse became excessively weak, quick and flut- 
tering, — the urine and faeces were passed invol- 
untarily — the breathing became slower and slow- 
er, until death closed the scene. 

All the patients that \ lost by fever not only 
during the Epidemic, but through the whole of 

*This circumstance occurred in several instances. The presence 
of the liquid seemed to excite the fauces to an effort for its removal, 
although not sufficiently, to cause it to be swallowed : either because 
the natural associations were destroyed, or the powers of the will had 
become indistinct. The force with which the fluids were sometimes 
thrown out was surprising. I have seen them thrown more than the 
length of the bed, on which the patient lay, sprinkling the clothes 
and persons of the attendants, in every direction. 



7b DESCRIPTION AND SYMPTOMS 

my residence in Gardiner, died in this manner. 
In the Epidemic, the period from the time when 
the most flattering hopes were rationally indulg- 
ed, to the fatal termination was, from about 
twelve to twenty hours. But several of the last 
hours were after the patient had ceased to take 
any thing into his stomach. It is remarkable that 
the skin continued to be susceptible to the ac- 
tion of blisters, until a very short time before 
death. 

As many who were attacked by this fever 
escaped the vomiting stage, so there were others, 
who after passing through both the preceding 
stages, escaped the comatose. In the early part 
of the season the accession of coma was much 
less common, than it was at a later period of the 
Epidemic. Until latein March, very few cases 
occurred in which this was a prominent symptom. 
As the weather became warmer, it was more fre- 
quent ; so that in April and May, almost every 
severe case was more or less inclined to it. 
Among those who were in some degree subject 
to coma, the greatest part were preserved from 
the deepest state of it. If proper care had been 
taken to support the strength of the patient, in 
the earlier periods of the disease, the accession 
of coma, generally gave very little cause of 
alarm, unless it w r as produced by the mismanage- 
ment of the attendants. 



OF THE FEVER. Tt 

But it was extremely difficult, and often im- 
possible to impress them sufficiently with the 
importance of watchfulness, and the danger of 
remissness in the application of remedies, when 
this symptom first appeared* Having witnessed 
the previous sufferings and exhaustion of the 
patient, they were exceedingly inclined to 
omit giving him the medicines, nearly so often as 
they had been prescribed ; in order that he might 
be permitted to sleep a longer time, without dis- 
turbance. The coma approached so insidiously, 
that it gave them no alarm, -until it had advanced 
so far as to render it very difficult to administer 
the remedies, which should arrest its progress ; 
and in some cases it became impracticable, be- 
fore they were aware, that the situation of the 
patient was particularly dangerous. Thus at the 
very moment, when more than at any other, it 
was of the utmost importance, to support the 
strength with the most active diligence, the 
means intended for this purpose were neglected, 
until it became almost impossible to use them. 
In this manner several patients died. I had left 
them, in every respect getting better. At my 
next visit, I found them irrecoverably sunk into a 
deep sleep. Their attendants seeing them inclin- 
ed to sleep, notwithstanding my constant and 
earnest directions, had suffered them to remain 
for several hours in succession, almost without 
disturbance, in the mistaken belief that rest was 
11 



73 DESCRIPTION AND SYMPTOMS 

more important to them, than nourishment or me- 
dicine ; and it was not until they ceased to swallow 
them, that this vain confidence was destroyed. 
In similar cases, if the powers of deglutition were 
not gone, or very nearly gone, before I arrived, 
we were still able to excite the dormant facul- 
ties, to the performance of their functions. 

But in cases where the strength had been 
carefully supported from the first, and where, on 
the appearance of the comatose state, the patient 
and his attendants were disposed to second the 
exertions of the physician, with unremitting 
watchfulness and diligence, the disposition to 
excessive drowsiness soon subsided, and the pa- 
tient became at once decidedly convalescent. 

In a few very severe cases a strong disposition 
to coma appeared, in the very commencement of 
the disease. It disappeared with the other symp- 
toms of the first stage, when the skin became 
moist, and the vomiting came on. 

THE CONVALESCENT STAGE. 

I have already observed that the fatal cases of 
the disease under consideration, always terminat- 
ed in the comatose stage. It only remains to 
speak of the more favorable terminations, and to 
describe the appearances and phenomena during 



OF THE FEVER. 79 

the recovery to health. Here again the symp- 
toms were as various, in their nature, order and 
duration, as they had been at any preceding 
period. 

The recovery was characterized in general by 
a subsidence, more or less gradual, of all the 
symptoms which had constituted the disease. But 
this was not generally in a steady uninterrupted 
course of improvement. Frequent and sudden 
relapses often occurred, especially if the case 
had been a severe one ; and new symptoms ap- 
peared, which had not formed any part of the 
previous disease. 

The first and most essential symptom of the 
convalescence, one in fact without which the pa- 
tient immediately ceased to be convalescent, was 
a genial,uniform moisture upon the skin. It was im- 
portant in this, as well as in the preceding stages, 
that this diaphoresis should be continued without 
interruption, and without being suffered to be- 
come excessive. If it was checked, even for an hour 
or two only, many of the symptoms of the first 
stage of the disease would immediately recur. 
On the contrary, if the evacuation was profuse, 
the patient was much exhausted by it, and was 
exceedingly liable to relapse, soon after, into dry- 
ness of the skin, and other bad symptoms. In the 
early part of the recovery, it required a con 



86 DESCRIPTION AND SYMPTOMS 

siderable degree of watchfulness and care, to pre- 
serve the skin in that state of genial perspiration, 
which was so desirable. But as the cure advanc- 
ed, there was less and less tendency, either to an 
obstruction or an excess of this secretion. 

The appearance of fullness of the skin dimi- 
nished, as the patient returned to health. The 
previously bloated, and almost cedematous state 
of the body had concealed the emaciation, which 
is always the consequence of severe diseases. As 
this state declined, especially in those cases, 
which had been long continued, it left a sort of 
ghastliness of countenance, which to the inexpe- 
rienced, was often more unpleasant than that 
which had preceded it. The physician, however, 
could not be deceived by it. For although the 
countenance was thin and sunken, it had the ex- 
pression and animation of returning health. 

During the whole course of the convalescence, 
until the cure was perfectly completed, most 
persons were subject to occasional attacks of 
pain and numbness, either together or separate. 
The pain was of short duration in any one place, 
but often severe while it continued. Being re- 
moved from one part, which was generally done 
with great facility, it seemed to be entirely cured 
for some time, and then suddenly made its ap- 
pearance in another, with a severity like that of 



OF THE FEVER. ol 

rheumatism. The numbness, whether it accom- 
panied the pain or attacked by itself, was subject 
to the same irregularities, and was generally re- 
moved by similar means. 

After the epidemic season had considerably 
advanced, an eruption on the skin became a very 
common symptom, during the recovery. It did 
not appear in but few, if any cases, before about 
the first of April; but after that time, almost every 
patient was subject to it. It varied in its appear- 
ance in different cases, but generally was a slight 
efflorescence on the skin, attended with redness, 
heat and itching. The skin was very slightly 
elevated, and uneven, but commonly not pimpled. 
It subsided in two or three days, of its own ac- 
cord, leaving a branny scurf upon the skin, from 
the desquamation of the cuticle. 

This eruption seems not to have been in any 
degree critical. It did not usually come on un- 
til after the most severe symptoms of the disease 
had been relieved, for several days ; arid it was 
not attended or followed, by any very observable 
additional amendment. Neither on the other 
hand, did it appear to increase the fever, or 
in any way add to the sufferings of the pa- 
tient, except by the external heat and irritation, 
which were not often severe. It may perhaps be 
a question whether the eruption is not to be attri- 



U'l DESCRIPTION AND SYMPTOMS 

buted to the treatment, rather than to the disease 
itself. If this were the case, I see no good rea- 
son why it should not have begun earlier in the 
disease, and continued longer. The most proba- 
ble time for the perspiration to have produced 
an eruption, would have been immediately after 
the skin resumed the exercise of its functions ; 
whereas this did not appear, until several days had 
elapsed. Besides, how was it that the eruption 
subsided and disappeared, while the perspiration 
and treatment remained the same, if they were 
the cause of it ? The question however is of very 
little practical importance, for the inconveniences 
which were produced by the eruption were so 
slight, as hardly to amount to an objection to the 
mode of treatment, even if we allow it to have 
been attributable to this cause. 

.Another common affection of the skin and cel- 
lular membrane, during the convalescence, was 
a species of boil or carbuncle. It did not com- 
mence until the cure was considerably advanced, 
generally several days after the eruption had dis- 
appeared, and sometimes not until the patient had 
so far recovered, as to have left his chamber. It 
was an exceedingly painful swelling, beginning 
in the form of a small pustule ; which discharged 
a slight quantity of yellowish ichorous fluid, and 
was surrounded by an areola, which was of a bright 
red colour, and hard ; the hardness extending deep 



OF THE FEVER. 83 

Into the cellular substance, and attended by a burn- 
ing, itching sort of pain. As the inflammation 
rapidly extended itself, the centre became con- 
siderably elevated, and changed to a deep purple, 
and almost black colour. In a few clays it ulcer- 
ated, and cast off a gangrenous slough, and then 
soon healed. The discharge from it was never 
very copious. These tumours varied very much 
in their size, and in the extent of the inflammation. 
In some, the slough was not larger than a small 
pea, and the areola not more than two or three 
inches in circumference. In others, the slough 
was an inch or more in circumference, and the 
circle of inflammation as large as a small plate. 
Every part of the body was subject to them ; but 
they were particularly frequent on surfaces, from 
which blisters had healed. Several small ones 
often appeared together, in these situations. The 
breast, in males as well as females, was a fre- 
quent place of their attack. Generally the same 
patient was not subject to many of them; but in 
a few instances, new ones appeared as the old ones 
healed, for a considerable length of time. 

The same species of tumour was very common 
among those who had not been sick with the fever. 
In these cases, it did not appear to operate as an 
effectual preventive of the fever, if they exerted 
any influence of this kind; for in several instan- 
ces, those who had recovered of them, afterwards 



84 DESCRIPTION AND SYMPTOMS 

went through a course of the fever. I do not re- 
collect any instance of a person, who had perfect- 
ly recovered from the fever, being affected with 
carbuncles. 



In this period of the disease, the tongue, which 
had already become moist, began to part with its 
coat, first at the edges, and gradually, as the cure 
advanced, from its whole surface. It generally 
lost very little of its dark colour, except as the 
coat separated. In some instances, especially ra- 
ther late in the season, the coat separated prema- 
turely, leaving the tongue and fauces naked and 
sore. In a few others it was retained to an un- 
usually late period. I one day met a patient 
who had been extremely sick, but had recovered 
so as to be able to walk out several times, stand- 
ing in the street some distance from home, exhibit- 
ing his tongue to his neighbours as a curiosity. 
It had a stripe, about half an inch in width, through 
the middle of its upper surface, which was cover- 
ed with a thick and perfectly black coat. The 
rest of the tongue had a healthy appearance. 

When there had been a cough in the earlier 
part of the disease, it gradually subsided by a 
free and easy expectoration. The matter expec- 
torated was a thick mucus, in some cases, streak- 
ed with blood. In a very few instances, early in 
the season, a cough commenced after the severe 






• 
J" 



•# 



OF THE FEVER. 85 

symptoms of the attack had subsided, and where 
there had been no symptoms of a pneumonic af- 
fection at the beginning of the disease. It was 
attended by a bloody expectoration, as in other 
cases, and went off in the course of the cure, with- 
out difficulty. 

In some cases, the appetite for food had not 
been wholly lost, even in the worst of the preced- 
ing stages of the fever ; and in others where it 
had been destroyed, it commonly re-appeared 
pretty early in the convalescence. The patients 
at first fed principally upon simple soups, and 
relished them well. But some time before the 
cure was completed, they commonly began to 
desire more solid food, and to express a dislike for 
liquid nourishment. The appetite was at this, 
time often excessively capricious, craving articles 
of diet, apparently very unsuitable to the situa- 
tion of the patient. Salt meat, salt fish, cheese, 
and pickles were some of the articles which were 
most frequently and earnestly desired. 

Where these cravings were urgent and contin- 
ued, I generally allowed them to be satisfied, 
though with much caution and moderation ; and 
in no instance did there any injury result from the 
indulgence, if proper care had been taken to dis- 
tinguish the whims of a restless patient, from the 
12 



** 



A- 



\* 






oG DESCRIPTION AND SYMPTOM* 

desires of an unnatural appetite ; a distinction 
which was in most cases easily made. 

In much the greatest proportion of cases, the 
pulse was gradually reduced in frequency and 
raised in strength as the patient recovered. 
In a considerable number, however, it sudden- 
ly became preternaturally slow, early in the 
convalescence. This happened particularly often 
in the first part of the season. In some in- 
stances, after continuing slow for several days, it 
suddenly resumed nearly its former quickness ; in 
others, it gradually recovered its natural quick- 
ness, as the strength of the patient was restored. 

Such were the most obvious and important 
changes which took place, during the recovery 
from this fever. They were almost infinitely di- 
versified, by the irregularity, with which they ap- 
peared at different periods, and the variety of 
their combinations. Relapses, and partial relapses 
were perpetually varying the appearance of the 
disease, and mingling the symptoms confusedly 
with each other. Yet notwithstanding these ir- 
regularities and relapses, the recoveries were ge- 
nerally rapid and complete. 

In a few instances the disease was prolonged 
by untoward circumstances ; but in most, the pa- 
tients were out of their chambers, within a week 



i 



• 



%, 



» 



* ♦ * 



% 



OF THE FEVER. 87 

• 

or ten days from the commencement of the con- 
valescence. The restoration to health was in al- 
most all cases, perfect. Several persons who 
had previously been rather feeble, had better 
health after their recovery from the fever, than 
before they were attacked by it. Only two or 
three of my patients became subject to chronic 
illness, in consequence of having suffered from 
the fever ; and these probably owed their sub- 
sequent debility, more to their own mismanage- 
ment, than to the inherent nature of the disease. 

GENERAL OBSERVATIONS. 

I am apprehensive that the preceding descrip- 
tion, conveys an impression of regularity and 
uniformity, in the symptoms of this disease, much 
greater than it actually exhibited. It is not to be 
forgotten that, although order and arrangement 
are indispensable in the description, they were 
constantly interrupted, in the disease itself, by 
the frequent appearance of anomalous symptoms, 
and the perpetual intermingling of many of the 
symptoms of the different stages. 

At any period of the disease, if by any m<eans 
the perspiration was checked, and the skin suffer- 
ed to become dry, many of the symptoms of the 
access were immediately renewed, and formed ir- 
regular combinations with those which previously 






m 



88 DESCRIPTION AND SYMPTOMS 

existed. This occurrence was particularly like- 
ly to happen, upon any sudden change of the 
weather from warmer to colder. Whether the 
effect of this change is to be ascribed to the ne- 
glect, or the difficulty, of suitably adjusting the 
bed-cloths to the wants of the patient, in this new 
state of the atmosphere ; or to any peculiar influ- 
ence which the air itself, or the cold suddenly apr 
plied, might exert upon the disease, I shall not 
stop to inquire. The fact is sufficiently appa- 
rent, that in a very large proportion of cases, the 
patient suddenly became much worse, whenever 
such a change in the temperature of the atmos- 
phere occurred. 

It will be proper here to take notice of a vari- 
ety of symptoms, which occasionally appeared, 
but which were not sufficiently prevalent, or not 
sufficiently constant in their time of appearance, 
to enter into the preceding description. 

I have already observed that during the con- 
valescence, the coat upon the tongue sometimes 
separated prematurely, leaving a soreness of the 
tongue and fauces. In a very few instances, this 
separation took place very early in the disease ; 
and once or twice, without producing the sore- 
ness here spoken of. In this last case, although 
the patient was very sick, and in the worst stage 
©f the fever, the tongue for several days exhibit- 



OF THE FEVER. 



89 



ed no marks of disease whatever. Wherever 
this premature separation had taken place, a new 
and slighter coat appeared upon the tongue, after 
a few days, which was removed in the progress 
of the cure. 

A soreness of the mouth and throat sometimes 
occurred, without any preternatural nakedness 
of the tongue. In a few cases this symptom ap- 
peared very much like an ordinary sore throat ; 
especially where the patient had been affected 
with a cough. In others, it was a swelling and 
inflammation of the gums and fauces, and was 
accompanied by a partial salivation. This was 
not a mercurial salivation, for it occurred in 
cases where the patient had taken no mercury in 
any shape ; and in several instances it appeared 
at the very commencement of the disease, before 
any medicine whatever had been administered. 
This symptom seemed to have very little influ- 
ence upon the general disease, and did not re- 
quire any other modification of the treatment, 
than to relieve the temporary inconveniences it 
occasioned ; except in a very few cases, in which 
the soreness of the throat rendered the patient 
unwilling to take the necessary remedies, in con- 
sequence of the pain produced by swallowing;. 
It generally went off in two or three days with- 
out any difficulty. 



M> DESCRIPTION AAD SYMPTOMS 

1 had one case, in which an inflammation at- 
tacked the left eye, on the third day of the dis- 
ease, and in a day or two became very violent. 
It was principally confined to the upper eye-lid, 
which swelled so as to overlap the other, and en- 
tirely to close the eye. It however disappeared 
in a few days without suppuration, merely by 
the application of a solution of acetite of lead. 

It is remarkable, that in some even severe 
cases, the sense of taste was not destroyed, nor 
very considerably impaired, in any stage of the 
disease. Although the tongue was covered 
with a thick coat, some patients would take food in 
considerable quantity, w r ith almost as much relish 
as in health. Even solid, hearty food, such as 
boiled salted meat, was in a very few instances 
desired, though of course not allowed. In the 
same manner, the taste for tobacco continued in 
some of those who had been accustomed to its 
use. 

I had a patient pretty severely affected by 
the fever, who remarked to me one day that he 
not only could chew his tobacco, as in health, 
which he never could do in any previous sick- 
ness, but he could also swallow the juice of it with 
his saliva, a thing which he could never do, w T hen 
he was in health. A day ortw r o after this conversa- 
tion, he grew very ill in the afternoon, complain'- 



4 



OP THE fEYEK. 91 

ed of great distress at his stomach, with extreme 
faint ness, with a cold clammy sweat over the 
whole body. These symptoms increased in se- 
verity until about twelve o'clock, when he vo- 
mited and was relieved. At my visit next day, 
I found on inquiry that he had been induced, by 
observing the facility with which he had swallow- 
ed the juice of tobacco, to extend his experiment 
still farther, and had actually eaten a pretty large 
piece of the manufactured herb. He attempted 
to repeat his experiment, at a subsequent peri- 
od, during his convalescence ; but his stomach 
had recovered the use of its functions, too much 
to permit him to succeed in swallowing it. 

Delirium is mentioned among the symptoms, 
with which the fever frequently commenced its 
attack. This was in most cases mild and of short 
duration. In one instance, however, it was wild 
and raving, and continued through the whole 
course of the disease, which was long and severe. 
The other symptoms of the case had nothing- 
very peculiar in them ; nor was the treatment 
g yery different from that of others, except the free 
application of blisters, and of cold to the head. 
The patient recovered. 

Two cases occurred under my observation of 

* singular affections of the larynx, which deserve 

to be mentioned. One was a total loss of the 



* * 



* 






92 DESCRIPTION AND SYMPTOMS 

voice. The patient bad been sick several days, 
and bad begun to get better, when he fatigued 
himself, by talking a good deal with a friend. 
The next day his voice was very much broken, 
and the day following was entirely gone. He 
could articulate, in a whisper, with perfect dis- 
tinctness ; but could not make a loud sound of 
any kind. This continued two or three weeks. 
Indeed he did not perfectly recover his voice 
until he had repeatedly taken exercise in the 
open air. It was afterwards perfectly restored. 
The other affection referred to, assumed the ap- 
pearance of croup. The patient, a boy about a 
year old, had a constant hoarse cough, for the 
first two days ; and was at irregular intervals 
subject to difficulty of breathing, with the pecu- 
liar stridulous sound which characterizes the 
croup. At other times the respiration was free 
and easy. This symptom disappeared in two or 
three days, and the patient soon after recovered. 

It is very remarkable that there were some 
organs, which seemed generally to partake in 
but a very slight degree, if at all, in the disease 
tinder which the system was labouring. They 
continued to perform their functions, with near- 
ly the same regularity as in health. This was 
more particularly the case with some of the ab- 
dominal viscera. The bowels showed but very 
slight marks of disease, except in a very few 



•A i 






* $ 






OF THE FEVER. 93 

cases. There were a few instances of diarrhoea 
in the commencement of the disease ; and it 
sometimes made its appearance at a later period. 
In this last case, however, the diarrhoea could 
generally be readily traced to some article of 
diet or medicine, which the patient had taken. 
There was much more often a tendency to cos- 
tiveness, than to diarrhoea. This might be the 
effect of the opium, which was always adminis; 
tered in greater or less quantities ; or it might, 
in part, result from torpor of the bowels, produc- 
ed by disease. Whatever might be the cause, 
the disposition to costiveness was not generally 
productive of much serious inconvenience, as it 
was readily removed by the mildest cathartics, or 
by emollient injections. In some cases it was 
more troublesome, giving rise to flatulence and 
pain in the bowels, and requiring more active ca- 
thartics, than the strength of the patient could 
well bear. Indeed in most cases the bowels in 
a slight degree partook, in common with the 
limbs and other parts of the body, of the liability 
to irregular wandering pains. But these pains 
did not generally require much attention, as 
they were rarely severe, and were easily re- 
moved. 

The urinary organs also appear to have been 
in general, very little affected during this fever. 
I find in my case-book no notice of any affection 

13 



1)4 DESCRIPTION Atffi SYMPTOM? 

of these organs; nor do T recollect any, except a 
flight degree of dysuria, which sometimes oc- 
curred. This dysuria might generally be the ef- 
fect of absorption from the blistering plasters 
which had been applied ; or it might be pro- 
duced by a partial retention of urine, occasioned 
by the torpid action of the muscular coat of the 
bladder : or more probably, it was the effect of 
both these causes combined. The retention and 
pain were readily relieved by friction of the bow- 
els with oil, and were prevented from recurring 
bv administering mucilaginous drinks. 

The uterine system in females, seemed equally 
free from any participation in the disease. The 
menses sometimes appeared in their regular 
course during the fever, and without modifying 
scarcely a symptom of it. In a few cases they 
appeared prematurely ; but their effects were 
equally unimportant. No instance of an immo- 
derate menstrual evacuation during the fever oc- 
curred in my practice. A state of pregnancy, or 
of child-bed does not appear to have rendered 
women any more liable to the fever ; nor was a 
miscarriage in any instance occasioned by it. 
Cases of pregnancy combined with fever, were 
not perhaps very numerous, though some certain- 
ly occurred, and without any apparent inconve- 
nience to the future offspring. There were se- 
veral instances in which women far advanced in 



OF THE FEVER. V)»> 

pregnancy, had the care of persons sick with the 
fever, without themselves becoming the subjects 
of it. Of a considerable number of women who 
were confined during the prevalence of the Epi- 
demic, all recovered from the puerperal state, 
without any attack of fever. The only case 
in which there could be any possible relation, be- 
tween the puerperal state and a subsequent fever, 
was a lady whose child was nearly two months 
old, and who had been in usual health, two or 
three weeks, before she was seized with the fever. 

Her sickness was severe, but did not manifest anv 

7 * 

peculiar symptoms, which could in any degree 
be referred to her previous confinement. Her 
infant was taken from the breast, but was restored 
after her recovery ; and she was able to nurse it 
as before, the secretion of milk not having been 
materially affected. 

I have hitherto said nothing of any spots upon 
the skin, although their real or supposed appear- 
ance has in many places given a name to the dis- 
ease. The reason is, that I have very little to 
say respecting them. In most or all of the fatal 
cases, just before death, small patches of a purple 
or rather livid colour were irregularly dispersed 
over the surface of the body. They had a con- 
siderable resemblance in their appearance, to small 
extravasations of blood into the cellular mem- 
brane, and were probably produced by the stag- 



96 DESCRIPTION AND SYMPTOMS 

nation of that fluid, in the small vessels of the skin. 
In two or three other cases, spots somewhat simi- 
lar to these in their appearance, but of a less livid 
colour, were discovered at an earlier stage of the 
disease. But they occurred early in the season, 
and only where the fever had continued several 
days, without any steps having been taken for its 
removal. They disappeared as soon as the skin 
was excited to action, either by friction, or by in- 
ternal remedies. I have never observed any ten- 
dency to the production of these spots, while the 
skin was moist, except in the fatal cases already 
mentioned ; unless the eruption formerly describ- 
ed as taking place during the convalescence, is to 
be confounded with them ; and this was exceeding- 
ly dissimilar in its appearance. 

There was one circumstance relating to this 
fever, which I mention with diffidence as a symp- 
tom of disease, though from the frequency of its 
occurrence, I think it entitled to some notice. 
Whenever the situation and feelings of the pa- 
tient were such, as to induce him to regard him- 
self as in danger of speedy death, he appeared to 
be entirely exempt from the alarm and anxiety, 
which such a state of things usually produces. 
He had no terror at the prospect of dying, nor 
any fearful anticipations, as to what awaited him 
beyond the grave. But on the contrary, he seem- 
ed to be elevated above every subject of appre- 



OF THE FEVEK. 07 

hension, and was filled with joyous exultation in 
the contemplation of futurity. 

Had this peculiar excitement at the expecta- 
tion of death been less general, or had it been con- 
fined to any particular class of people, or to any re- 
ligious denomination, I might have regarded it as 
the effect of religious ardour, or enthusiasm. 
But it was almost as universal, as the state of the 
disease in which it appeared. Whatever might 
be the situation in life of the patient, if he was 
only of an age to express his feelings ; whatever 
his religious opinions, or his moral or religious 
character, he was alike subject to this singular ele- 
vation of feelings, at the prospect of death. It 
was not of course during the comatose stage, 
when death seemed actually the nearest, that this 
state of the mind was manifested, for he was then 
equally insensible to the hopes of life or death. 
It generally happened during the exhaustion pro- 
duced by a protracted continuance of the vomit- 
ing stage, although it occasionally appeared in 
consequence of a relapse, at other periods of the 
disease. 

This circumstance displays in a striking man- 
ner the influence which diseases may have upon 
the state of the mind and feelings, and the impro- 
priety of regarding these feelings as indicative of 
the past character, or the future prospects of a 



98 DESCRIPTION AND . SYMPTOMS 

dying patient. But I shall not stop to take notice 
of the uses which the christian moralist might 
make of it, nor to inquire into its probable 
causes. I mention it, because it was one among 
the multitude of phenomena which this disease 
exhibited. 



OF THE CRISIS AND DURATION OF THE FEVER. 

I have no means of ascertaining very accu- 
rately, how long this fever would have continued 
to rage, if it had been left to itself; or whether it 
would ever have been disposed to throw itself 
off, by a crisis of its own formation. The disease 
w 7 as generally taken out of the hands of nature, 
very soon after its commencement. In every 
case that came under my observation, remedies 
were applied immediately upon my first seeing 
the patient ; and in many instances, some appli- 
cations had been made before my arrival. Al- 
though in consequence of the lightness of the 
attack, application to a physician was sometimes 
delayed several days, something was generally 
done by the patient or his friends, to endeavour 
to remove the disease, soon after it began. 

Early in the season, however, before an alarm 
was excited by the prevalence of the Epidemic, 
two or three cases occurred, in which very little 
if any thing was done to effect a cure, during the 



OF THE FEVER. 99 

first three or four days of the disease. In each 
of these cases, it had commenced in its mildest 
form ; but it grew constantly worse, until arrest- 
ed by the application of remedies. There was 
not manifested in any instance, the least disposi- 
tion in the symptoms to remit, until forced to 
yield to the power of medicine. In the more se- 
vere attacks, the progress of the disease was so 
rapid, that there could hardly have been time for 
a perfect crisis to form, had there been any dis- 
position to it. If to these considerations, we add 
the constant disposition which the disease mani- 
fested, after it had been arrested by medicines, to 
relapse whenever their exhibition was suspended, 
I think we may pretty fairly conclude, that in 
most cases at least, the only natural crisis would 
have been death. 

When the cure was effected by medicine, no- 
thing appeared like the crisis which is described, 
as having anciently taken place in fevers : where 
after a certain length of time, the disease assumed 
a disposition to return voluntarily to health. On 
the contrary, every step was obstinately disput- 
ed ; and until the cure was firmly established, the 
most vigorous exertions, and unremitting vigi- 
lance were necessary, to prevent a recurrence of 
the bad symptoms, which had been relieved. The 
principal circumstance which had in any degree 
the appearance of a crisis, was the diaphoresis, 



100 DESCRIPTION AND SYMPTOMS 

But this, after il had been produced (as it always 
was) by artificial means, showed no disposition to 
continue any considerable length of time, with- 
out the continuance of those means. Nor was it 
ever effectual to remove the disease, without the 
concurrence of other circumstances, which acted 
independently of this. 

The duration of the disease was exceedingly 
various, according as medical aid was called ear- 
lier or later in the disease, and as the patient and 
his attendants were more or less vigilant in the 
application of the remedies prescribed ; as well as 
to the severity of the attack, and a variety of 
other circumstances which are not under human 
control. In a very considerable number of cases, 
where I was called at the commencement of the 
disease, we were able to arrest it so completely, 
that the patient recovered immediately ; and it 
was not necessary to prolong my visits beyond 
the third day. Others continued longer, so as to 
require attendance from four to ten, or twelve, 
and a few, fourteen days ; and very rarely longer. 
In more than half the cases, my visits were not 
extended beyond the first week. It may be proper 
to remark here, that in consequence of the num- 
ber of the sick, and the distance between them, 
I often left my patients earlier in the convales- 
cence, than I otherwise should have done. When 
they had so far recovered, as to be able to sit up. 



OP THE FEVER, 101 

an hour at a time without injury, unless there was 
some special circumstance to prevent, I generally 
discontinued my visits. This was before they 
were out of the danger of a relapse ; but the uni- 
formity of the management required for the last 
stage of the convalescence, rendered the farther 
attendance of a physician less necessary. 

Of the fatal cases, two died on the second day from 
the attack, one the third, one the ninth, one the 
thirteenth, one the sixteenth, and one the twenty- 
second. All of these, who lived beyond the third 
day, had become decidedly convalescent, and re- 
lapsed, before they died. These seven were the 
only deaths that occurred, in my practice, during 
the prevalence of the Epidemic ; and of these, it 
will hereafter appear that most, if not all were to 
be ascribed to circumstances, which were contin- 
gent and accidental, rather than inherent in the 
nature of the disease, or dependent upon the treat- 
ment which it generally received. 

I trust it is unnecessary to say, that in this state- 
ment of fatal terminations, I have not confined 
myself to those only, which I consider as having 
strictly been produced by the fever; but have 
included all who died after having been affected 
with it, whatever might have been the imme- 
diate cause of death. Indeed this statement 
includes all the deaths that occurred in my prae- 

14 



102 DESCRIPTION AND SYMPTOM? 

tice during the prevalence of the Epidemic; ex- 
cept that of one child, which was produced by 
dentition, complicated with catarrh, attacking a 
habit of body so feeble, that at the age of more 
than two years, the child had never been able to 
walk. 

While the Epidemic prevailed, no other dis- 
eases made their appearance, except such as had 
their origin in some local affection. It will be 
seen by a reference to the tables, that I had seve- 
ral calls to children made sick by dentition, and 
a very few other local complaints, but to no ge- 
neral disease, except the fever under consideration. 
So true is it, that an Epidemic swallows up every 
other disease during its continuance. It was a 
remarkable result of this general law of nature, 
that the number of deaths in the town, seems al- 
most to have been diminished rather than increas- 
ed, by the prevalence of so powerful an Epidemic 
as this, which we have been describing. For al- 
though the first five months of the year 1314 
were probably more sickly than any other period 
of equal length, since the first settlement of the 
town, yet the number of deaths was less than it 
was during the same part of the year 1817, which 
was considered an unusually healthy season. I 
regret that the comparison cannot be extended to 
other years. But I have no data upon which to 
found it. My acquaintance with the distant parts 



OP THE FEVER. 103 

of the town was too limited to enable me to make 
accurate observations of this kind, unless there 
was something a little unusual to attract the no- 
tice of the inhabitants, as in the two years I have 
mentioned; and there are no records from which 
the requisite facts can be drawn. 

Those who had been once sick with this fever, 
and had recovered, were not thereby protected 
from a second attack. Several cases occurred un- 
der my observation, of persons who having gone 
through the fever, and who had been perfectly 
restored to their usual health, after continuing to 
be well for several weeks, were again seized, and 
obliged to undergo a second course of disease and 
suffering. In most of these cases the first sickness 
had been comparatively light, and the second was 
generally very severe, though in no instance fatak 
In a few others, the first sickness was severe and 
the second light. I believe there was no instance 
in which the same patient was subjected to two 
attacks, both of which were severe ; nor was any 
one attacked the third time with the disease, in 
the course of the season. 

This is perhaps the most suitable place to speak 
of the manner in which the disease extended from 
one person to another. Not indeed to discuss the 
question whether or not the disease was conta- 
gious, for I shall defer that question till all the 



104 DESCRIPTION AND SYMPTOMS 

facts are before the reader : but to furnish the 
statements upon which such a discussion must 
principally be founded. 

The disease was as variable and seemingly ca- 
pricious in the selection of its victims, as it often 
was in the subsequent disposal of them. There 
was a general tendency, when the fever appeared 
in a family, to subject a considerable proportion 
of its members to its influence. Yet in almost 
every family, into which it entered, some escaped 
its attacks, and in most, the number of those who 
were not severely affected, was greater than that 
of the sick. A few instances occurred, in which 
one person only, in the family, was seized, leaving 
the rest free through the whole season. Of those 
who were attacked, in families, where the disease 
had already prevailed, it often happened that 
those who had been the least with the sick were 
the first victims, while those who had been con- 
stantly employed in watching over and nursing 
the sick, often escaped. No particular reason can 
be given therefore, why those who were seized 
with the fever, should have been its victims in 
preference to others, who had been equally fa- 
miliar among the sick, and equally exposed to 
fatigue. 

Neither was the disease confined to those who 
might be supposed to have been exposed to its 



OP THE FEVER. 10.) 

influence in others. It often attacked persons 
woo had not been near the sick, and appeared in 
families, not one of which had seen a case of it. 
Sometimes two or three persons in a family, living 
at a distance from where the disease had before 
raged, were attacked almost at the same time, or 
in such immediate succession as to preclude the 
possibility of a communication of the disease from 
one to another. In other instances several fami- 
lies in a neighbourhood became nearly at the 
same time subject to it3 ravages, without having 
previously had any intercourse w r ith it. At the 
same time, there were other families, living in the 
village where its ravages were the greatest, in 
the immediate vicinity of the sick, and perform- 
ing all the kind offices of good neighbourhood, 
by which a constant intercourse was kept up with 
them, which were entirely passed over by the dis- 
ease. In like manner, several individuals who 
were the most active, in visiting and supplying 
the wants of the poor, that were sick, and who 
frequently saw the disease in its worst forms, and 
while exposed to great fatigue, were nevertheless 
entirely free from its influence upon themselves. 

The following cases will serve to exemplify 
these various modes in which the disease was ex- 
tended. 



106 DESCRIPTION AND SYMPTOMS 

Abigail L. was the first person who came un- 
der my care sick with the fever. She was taken 
the 7th of February. The Epidemic had not 
then appeared in town, and she had not been ex- 
posed to it, any where else. February 25th, her 
sister Sally began to complain. She had lived 
constantly in the same house, and been engaged 
in various offices for her sister, although she had 
not had the immediate care of her. March 5th, 
Solomon L. was taken pretty violently. He is a 
brother of the others, but had not lived in the 
same house ; and being actively engaged in busi- 
ness had only visited them occasionally. March 
13th, Benjamin L.'another brother who is married, 
and lives in the house with his sisters was seized 
w r ith great violence ; but recovered in a few days. 
He lived in another part of the house, and had 
no particular care of the sick, though he was in 
the room frequently. March 16th, Mrs. J. a sis- 
ter of the others, who lived at a little distance, 
and in whose family Solomon resided, was at- 
tacked. She had been frequently with her sisters, 
and had taken the principal care of Solomon. 
March 17th, Mr. L. father of the others began to 
be ill, though he was not so sick as to call a phy- 
sician, till several days later. He had not been 
very constantly in the sick rooms, but had been 
much exposed to fatigue, in attending to the out- 
of-door concerns of his sick family, and had been 
much depressed by the weight of affliction which 



OF THE FEVER. 107 

he suffered. March 22d, R. T. a young woman, 
who had nursed Mrs. .1. became sick. April 1st, 
Samuel J. an elderly man, father of Mrs. J's. hus- 
band, was seized, and died the third day. He had 
had very little immediale communication with 
the sick, though he lived in the same house. April 
17 th, Mrs. L. wife of Mr. L. (who died on the 
30th ult.) was attacked. She had been constantly- 
employed in the sick rooms, ever since the dis- 
ease first appeared in her family ; and had been 
very much borne down by their complicated suf- 
ferings. The same day Mrs. J. wife of Samuel 
J. was taken sick. She had been constantly em- 
ployed in taking care of her husband, and the 
other members of her family, whose sickness had 
preceded hers. May 1st, Mr. T. a man w 7 ho was 
residing for a few days in the family of Mr. J. be- 
came sick. May 15th, William J. the husband 
of the first mentioned Mrs. J. was violently 
seized, and died the third day. He had not been 
much engaged in taking care of the sick ; but had 
exposed himself very much to cold, wet and fa- 
tigue. This w r as by far the most extensive, as 
well as the most destructive range, which the dis- 
ease took in any one family connexion. During 
all this time, the wife and child of Benjamin L. 
who had been constantly in the sick rooms, and a 
Mrs. D. who had been successively employed in 
nursing the different members of the family, and 
in performing the last and most disagreeable of- 
fices, for those who had died, and several persons 



108 DESCRIPTION AiND SYMPTOMS 

who had constantly lived in the family of the .1 's. 
were not at all affected by the disease. 

On the 21th of March, Mr. B. a gentleman 
eighty years of age,was very suddenly and violent- 
ly attacked by the fever. On the 31st, his wife, 
Mrs. B. was attacked and died the third day. 
April 1st, a young woman, their domestic, and the 
only remaining member of their family, was also 
violently seized. Immediately after Mr. B's. at- 
tack, his daughter Mrs. L. and her husband, and 
Mr. G. the husband of another daughter, with 
some of his familv, came to the house and remain- 
ed a great part of the time till his recovery. Mrs. 
G. having a young infant, did not come to stay 
until a week later ; and was afterwards prevented 
by the same circumstance from being, so much as 
the others, in the sick room. She was notwith- 
standing taken very sick on the 1 5th of April, and 
recovered with difficulty after some time, while 
neither of the others, who had constantly perform- 
ed all the offices of kindness and attention for 
the sick were affected. On the 16/^ of April, the 
only daughter of Mr. and Mrs. L. and their ser- 
vant girl, neither of whom, I believe, had ever 
been into a house in which the fever had prevailed, 
were both suddenly seized about the same time,, 
and with great violence. 



OF THE FEVER. 109 

April 8th, I. L. was attacked with the Epidemic. 
April 13th, one of his sons, and the 14th, another 
was also attacked. This family lived two or three 
miles from any house, in which the fever had be- 
fore appeared, and was the only one in the vici- 
nity, which was subject to it ; although their neigh- 
bours frequently visited them, and performed 
many of the duties of nursing for them during 
their sickness. No members of the family had 
been with the sick in any other house. 

In a little village about three miles from where 
the Epidemic had before appeared, Mrs. R. was 
taken sick on the 25th of March, as were two chil- 
dren in a family at a little distance. On the 26th, 
Mrs. R's daughter, and about the same time, a 
sister of the children just mentioned, and two 
children in another family in the vicinity were 
taken ; and on the 21th, another child in this last 
mentioned family. Here the disease stopped its 
progress in that neighbourhood. None of these 
persons had been with the sick, until the disease 
appeared in their own families. 

APPEARANCES AFTER DEATH. 

The livid spots which had begun a short time 
before, increased at the moment of death, and 
assumed much of the appearance of incipient 
sphacelation, for which they were often taken by 

14 a 



I JO DESCRIPTION AND SYMPTOMS, &C. 

the attendants. The lividity soon after extended 
over nearly the whole body ; the features were 
speedily dissolved, and in a few hours, symptoms 
of putrefaction commenced. Although the funeral 
was generally attended the second day, in most 
cases the body had become quite offensive be- 
fore it was committed to the earth. 

To this short sketch I would fain have added 
the appearances on dissection. But I have no 
materials from which to do it. I am not insensi- 
ble of the great importance of dissections, in in- 
vestigating the nature and character of diseases; 
and was not inattentive to this part of my profes- 
sional duties ; though from the circumstances in 
which I was placed, I was prevented from accom- 
plishing any thing. I faithfully sought opportu- 
nities to examine the bodies of the patients I lost ; 
but could not succeed in obtaining permission 
from the friends of the deceased. Such exami- 
nations had rarely been made at Gardiner; and 
the prejudices, which existed against them in the 
families in which deaths occurred, were too strong 
to be overcome by a young practitioner, unaided 
by the support of the senior counsel, who some- 
times met me in consultation. The very disposi- 
tion to inquiry, which the desire to make dissec- 
tions manifested, was a cause of suspicion with 
those who were ignorant of their usefulness. 



CHAPTER III. 



TREATMENT OF THE FEVER. 



It will not be necessary, in speaking of the treat- 
ment of this disease, to adhere very closely to the 
arrangement which I have adopted in the preced- 
ing chapter; nor to attempt to follow the course of 
the symptoms, in describing the remedies which 
were to remove them. There were certain ge- 
neral circumstances, which entered into the man- 
agement of every case, and of almost every stage 
of the disease. These, although few in number^ 
were of essential importance. There were many 
others, which were applicable only to the parti- 
cular symptoms of individual cases; and were 
consequently as various as the changing features 
of the Epidemic itself. 

The first and leading object, always was to re 
store, and continue in force the functions of the 
skin. The second, which was hardly less impor- 
tant, was to support the strength of the patient. 
The remainder of the cure was effected, by re- 



112 TREATMENT OP THE FEVER. 

moving the great variety of occasional symptoms 
which occurred. The means for accomplishing 
the two first objects, were pretty uniformly the 
same in the several cases. But for the last, the 
w r hole Materia Medica presented a field hardly 
enough variegated, for the complicated and per- 
petually changing evils to be removed. 

At the beginning of the Epidemic season, I 
pretty generally commenced the treatment, by 
administering an emetic. But not finding inmost 
cases, the benefit from its operation, which I had 
anticipated, I soon omitted it, except in cases 
where there had been symptoms of a derange- 
ment of the functions of the stomach, previously 
to the attack of fever. In these cases, an emetic 
at the commencement of the disease was of very 
great service, and sometimes entirely arrested its 
progress. 

Before the emetic was given, however, the pa- 
tient was put into bed, and pretty commonly had 
made use of the warm pediluvium. As soon as 
the operation of the emetic had ceased, or, if one 
had not been given, at the commencement of the 
treatment, I administered a powerful diaphoretic, 
which was repeated at intervals of from two to 
four hours, according to the urgency of the case. 
At the same time such external applications were 
often made, as should aid in the production of a 



TREATMENT OP THE FEVER. 113 

diaphoresis. These however were ordered to be 
discontinued, as soon as the perspiration com- 
menced; and were not afterwards renewed, un- 
less by accident, or inattention, the skin had been 
suffered to become dry. It frequently happened, 
that these applications were made before my ar- 
rival, so that I found the patient already in a pro- 
fuse sweat. In this case, I ordered the gradual 
removal of the external applications, and trusted 
to the medicines to keep up the diaphoresis. 

If the limbs were cold or numb, or subject to 
pain, directions were given that they should be 
diligently rubbed, either with the naked hand, or 
with flannel, either dry or moistened with oil, or 
with some stimulating liquid, such as vinegar, or 
alcohol, and sometimes with a solution of cantha- 
rides. The quantity of bed clothes was regulat- 
ed by the feelings of the patient. If he was cold, 
they were increased, so far as it could be done 
without oppressing him by their weight. If he 
was uncomfortably warm, they were lightened. 

The urgent desire for liquids which the thirst 
occasioned, was freely gratified by allowing what- 
ever drinks the patient chose. These were gene- 
rally, decoctions of some of the aromatic herbs, 
particularly peppermint, pennyroyal, and ground 
hemlock, or dwarf yew. They were taken in 
large quantities, and generally as hot as they couW 
15 



114 TREATMENT OF THE FEVER. 

be borne, because they were preferred in that 
state by the patient. In a very few cases in which 
they were more grateful when cold, they were 
not warmed. Indeed, I did not consider it neces- 
sary in the commencement of the disease, to re- 
fuse hardly any kind of drink, which a patient 
desired, whatever might be its nature or tempera- 
ture. In a subsequent part of the disease, more 
caution was requisite in selecting the means of 
removing the thirst ; because the appetite became 
a fallacious indication of what was needed to sup- 
ply the wants of the system. 

In this manner the cure was always begun, and 
in cases in which the strength was not particularly 
depressed, very little else was prescribed at the 
first visit, except an anodyne at bed time. In the 
first part of the season particularly, when the 
pulse was often considerably full and strong, and 
especially if there were symptoms of a pneumo- 
nic affection, I waited until these symptoms had 
somewhat remitted, before I began to administer 
the tonic remedies, which held a conspicuous place 
in the general plan of treatment. But when, as 
in a great proportion of cases, the strength was 
low from the first ; or if it had become so by the 
continuance of the disease, it was necessary in 
addition to the treatment already described, to 
take vigorous measures to prevent it from sink- 
ing altogether. For this purpose, small quanti- 



TREATMENT OF THE FEVER. lib 

ties of brand j were occasionally given in the 
drinks already mentioned, — a diet as nutritive as 
the patient could take was recommended, and a 
variety of medicinal tonics prescribed. 

Among the tonics, the principal reliance was 
upon the Cinchona Officinalis, which was com- 
monly given in the form of a compound decoc- 
tion, as follows, viz. 

R. Cinchon. Officinalis. §i. 

Citri Aurant. Cort. §ss. 

Aristol. Serpent. 3ii. 
A quart of boiling water was poured upon about 
one third of this quantity ; and it was then boiled 
in a qovered vessel ten minutes. After being 
removed from the fire, as soon as it was sufficient- 
ly cooled, a little yeast to the amount of a com- 
mon wine glass full, and as much simple syrup or 
molasses were added ; when it was set by, to fer- 
ment. In five or six hours it was ready for use. 
The most common method of giving this decoc- 
tion, was to direct the patient to drink a wine 
glass full every four hours, in the intervals be- 
tween the times of taking the diaphoretic pow- 
ders. Infusion of duassia was prescribed in some 
instances, where the cinchona did not agree well 
with the stomach, as were some other tonics. 

When symptoms of faintness or torpor appear- 
ed, at whatever period of the disease it might be, 



116 TREATMENT OF THE FEVER. 

the diffusible stimuli were diligently administered. 
The aromatic spirits and volatile oils in all their 
variety, were given in small doses frequently re- 
peated. A mixture of spirit of peppermint, com- 
pound spirit of lavender, and camphorated tinc- 
ture of opium, was more generally useful, than 
perhaps any other preparation of this class. But 
however efficacious they might be when first ex- 
hibited, it soon became necessary to vary them. 
For the stomach becoming accustomed to them, 
they lost much of their good effects ; and others, 
even if less powerful, were found more effectual 
in rousing the system to action. This was more 
especially the case, during the vomiting stage of 
the disease. 

The vomiting was a symptom, which, when it 
was severe, it required great diligence and care 
to remove. Only very small quantities of any 
substance could be received into the stomach at 
a time, with any chance of its being retained ; and 
only such articles as were stimulating in their na- 
ture. The diaphoretic powders were now, either 
altogether omitted, or only given in smaller doses, 
and at longer intervals. The fermented decoc- 
tion was sometimes retained on the stomach as 
well as any thing else, in which case it was con- 
tinued ; at others, it was necessary to omit it, 
because it was rejected by vomiting. The cor- 
dial mixture already mentioned, frequently re- 



TREATMENT OF THE FEVER. 117 

strained the vomiting for a short time. When 
that failed, various other volatile oils were tried 
in succession, each seeming to accomplish the 
purpose for a little while. But in some very bad 
cases, each in its turn was rejected, as soon as 
the stomach had become accustomed to its action. 
The volatile oils of lavender, rosemary, cinnamon, 
cloves, and turpentine were occasionally given, 
either singly, or combined with tincture of opium. 
A small quantity was dropped into any of the 
drinks which the patient was to take, and given 
by single tea-spoonfuls, taking care to have it as 
hot as could be borne. 

Indeed this was a caution which it was always 
indispensable to observe, in this state of the dis- 
ease. Whatever was given, it was necessary that 
it should be made as hot as could be taken 
without burning the mouth, and this in extremely 
small quantities. In this manner all the drink 
that was to quench the thirst of the patient, and 
all the food that was to nourish him, as well as all 
his medicines, were dealt out to him by tea-spoon- 
fuls. Even after the vomiting had been considera- 
bly subdued, if the stomach was suffered to get 
over-loaded, it commenced again, and was only 
conquered by renewing the same cautious 
management. 

Besides the remedies already mentioned as ap- 
plicable to this state of the disease, a variety of 



/ 



118 TREATMENT OF THE FEVER. 

other substances not strictly medicinal were fre- 
quently given. Brandy, sparingly diluted with 
some aromatic infusion, was often very effica- 
cious, in checking the vomiting, as well as in re- 
moving the sensation of extreme faintness, by 
which it was attended. The small quantities of 
food which the patient could take, were made as 
nourishing and as easy of digestion as possible, and 
were as highly seasoned with any spices which he 
might choose, as they could be made, without im- 
pairing his relish for them. A simple chicken soup 
was by most persons preferred to any other food, 
and was in general retained best upon the stomach. 
Some few, either from a general dislike to soup, 
or from some disgust to it excited during the 
sickness, preferred other articles of nourishment. 

Frictions with oil upon the region of the 
stomach, were often recommended with good ef- 
fect at this time. Fomentations, applied as hot 
as they could be borne, and sometimes blisters 
to the same part, were in some cases of great 
service. 

The difficulty of subduing the vomiting was 
very much increased by the constant, and some- 
times almost ravenous thirst for cold water ; a 
thirst which it was injurious and even dangerous 
to gratify. Even a very small quantity of water, 
taken at this period of the disease invariably ren- 



TREATMENT OF THE FEVER. J 19 

dered the vomiting more violent, and thus increas- 
ed the faintness and thirst, for which it was craved. 
Yet it was many times, difficult to convince the 
patient or his attendants that this would be the 
effect, until he had ascertained its certainty by 
experience ; especially as in other stages of the 
disease, water was sometimes allowed, not only 
with impunity, but with obvious advantage. 
Hence they were often inclined to judge for 
themselves, that it would be of service in their 
own case. The relapses from this cause were 
not commonly very serious, because the quantity 
at first taken was generally small. But they were 
sometimes more alarming. In one instance, in 
particular, an indulgence of this kind had well 
nigh cost a patient her life. Having heard an in- 
stance spoken of, in which water had been taken 
with advantage, she determined at whatever ha- 
zard, to try the experiment upon herself. Her 
nurse gratified her, and she drank pretty freely. 
Her vomiting, which had ceased for several hours* 
immediately returned, with great violence and 
obstinacy ; she complained of great coldness and 
faintness at the stomach, with a feeling of extreme 
depression and sinking; and pain in the head. 
Her countenance became more bloated. In short, 
she was every way much worse than before ; and 
was not restored to her former state until several 
days after. 



120 TREATMENT OP THE FEVER. 

By a diligent and careful application of the 
remedies above mentioned, the vomiting was al- 
ways sooner or later subdued. In most cases, 
where we were aided by the careful management 
of the attendants, only a few of them, and those 
not the most powerful, were necessary. In some 
obstinate cases, the first effectual relief seemed 
to be given, by gratifying the patient in an indul- 
gence of his appetite for some particular article, 
either of food or drink. Much caution was re- 
quisite in this indulgence ; but it was sometimes 
permitted with success. The articles desired were 
various, and often had no apparent suitableness to 
the situation of the patient. That which was 
most frequently and most ardently craved, was 
cider ; and it was more generally received with- 
out injury than any other. 

As soon as the vomiting was sufficiently sub- 
dued, it was of great importance that the strength 
of the patient should be diligently supported. 
The facility with which the coma, that in most 
cases was soon inclined to succeed, was prevent- 
ed or removed, depended in a very great degree, 
upon the diligence with which remedies were ap- 
plied immediately after the vomiting ceased. 
The patient was already considerably exhausted 
by the vomiting, and by the small quantity of 
nutriment which had been received in consequence 
of it. This exhaustion was to be removed, by 






TREATMENT OF THE FEVER. 121 

every means that could be adopted, without re- 
newing the symptom which had been one of its 
principal causes. For this purpose, more brandy 
was ordered to be given than before ; the ferment- 
ed decoction of cinchona was given in pretty large 
quantities, proportioned to the age of the patient ; 
and soup, or whatever other article of diet was 
preferred, was given very freely. At the same 
time, the diaphoretic powders were generally re- 
newed, though in smaller doses than at first. 
Strict injunctions were given, that the patient 
should not be suffered to sleep more than fifteen 
minutes at a time, without being waked sufficient- 
ly to take something. 

As the coma came on, tincture of opium with 
some of the strongest of the volatile oils, such as 
peppermint or lavender, was given in small doses, 
frequently repeated. Yeast and brandy were 
also given together at this time ; and if the coma 
continued to increase, carbonate of ammonia was 
added to the diaphoretic powders, or else dissolv- 
ed in some liquid, and administered by itself. 
At the same time, or rather at the commence- 
ment of the coma, blisters were applied to the 
back of the neck ; and if it had not already been 
done, earlier in the disease, stimulating applica- 
tions were made to the feet. Cold water, or vine- 
gar and water, and sometimes ice, were applied to 
the forehead and temples ; and in some cases to 

16 



122 TREATMENT OF THE FEVEK. 

the whole head. The trunk and extremities were 
diligently rubbed with vinegar, or with a solution 
of cantharides, taking particular care that the 
cold air should not be suffered to come in con- 
tact with the body. If these measures were not 
speedily efficacious, enemata composed of yeast, 
brandy, and tincture of opium, were thrown up ; 
and the quantity of these articles given by mouth 
was rapidly and largely increased. Indeed the 
only circumstance by which the exhibition of 
these articles could be regulated, was the effect 
which they produced. No quantity was consid- 
ered to be large enough, until the coma began 
to be subdued. When that remitted, these me- 
dicines were given more sparingly, and with great- 
er caution. This effect was uniformly produced 
by this course of remedies, unless the previous 
state of exhaustion had been extreme, or some 
unusual circumstance prevented the requisite 
quantity from being given. 

After the coma had disappeared, it was neces- 
sary to continue many of the medicines, which 
had been given in the preceding stages ; but in 
doses somewhat diminished, according to the cir- 
cumstances of the case. The diaphoretic pow- 
ders were generally ordered to be given at first 
every four hours ; then every six hours, and as 
the cure advanced only twice a day, until the 
skin performed its functions without their assist- 



TREATMENT OF THE FEVER. 123 

ance, when they were discontinued altogether. 
A small dose of camphorated tincture of opium 
was generally prescribed, to be taken at bed-time 
every night, from the first, and was continued 
through the greater part of the convalescence. 
The tonics were continued in greater or less 
quantity, according as they seemed to be needed. 
The fermented decoction in most cases still held 
its place, as the most grateful, as well as the most 
suitable article of this class, until the cure was 
nearly completed, when the compound tincture 
of cinchona was frequently substituted for it. 
Brandy was given in less quantities as the strength 
was recovered ; so as generally to be left off al- 
together, or nearly so, by the time my visits were 
discontinued. 

Soup, or such other liquid food as the patient 
preferred, continued to be the principal article of 
diet, until the appetite was so far restored as to 
produce a desire for solid food. Beefsteaks, or 
such other fresh meat as the season and market 
afforded, were then allowed. At first the meat 
was masticated, and only its juices swallowed ; 
afterwards the whole was eaten freely. 

The thirst was not urgent at this period of the 
disease, unless occasioned by a relapse, There 
was, however, a pretty general and strong desire 
for cider, which could not easily be removed, ex- 



J 21 TREATMENT OP THE FEVER. 

cept by its gratification. This was the case with 
many persons, who had not been much accustom- 
ed to drinking it in health, and with some even, 
to whom it had been rather disagreeable. 

It sometimes happened, after the cure had gone 
on perfectly well for several days, that the patient 
suddenly lost all 'relish for food of any kind, and 
rather loathed it, without any considerable in- 
crease of the febrile symptoms, except, perhaps, 
some degree of restlessness and anxiety. In this 
case, an emetic effectually removed the unfavor- 
able symptoms, and restored the patient to his 
state of progressive recovery. The kind of eme- 
tic which I preferred for this purpose, was the 
powdered ipecacuanha. If not sufficiently active 
of itself to evacuate the stomach effectually, I 
sometimes added a small quantity of sulphate of 
zinc. The nausea which continues after the ope- 
ration of tartrite of antimony, and the great debi- 
lity produced by it, were a serious objection to 
prescribing it at this period of the disease. 

During the whole progress of the treatment, 
costiveness was carefully guarded against, by ad- 
ministering either mild cathartics, or emollient 
injections, as often as they were needed. An 
enema was generally preferred, when the patient 
was quite feeble, provided I could depend upon 
its being effectually administered. But in this 



TREATMENT OP THE FEVER. IS. f ) 

I was often disappointed ; for although the ope- 
ration is a simple one, I found but few nurses, 
who were accustomed to performing it. Injec- 
tions of a different kind, and for a different pur- 
pose, were not unfrequently thrown up, when 
the patient was low, and not able to take a suffi- 
cient quantity of nutriment and medicine by 
mouth. They were then composed of soup with- 
out seasoning, a small quantity of brandy, and 
tincture of opium sufficient to ensure their re- 
tention. These were often administered with a 
very excellent effect, where the patient had be- 
come much reduced by a want of support and 
nourishment. 

Whenever pain or numbness in the limbs ap- 
peared, they were generally very readily remov- 
ed by frictions with oil. The same remedy 
applied to the bowels was often efficacious, in 
removing the pain and flatulence which not un- 
frequently occurred in the bowels, previously to 
the operation of a cathartic, and in relieving the 
partial retentions of urine which were some- 
times troublesome. 

Such are the general outlines of the practice, 
which I adopted for the removal of this formida- 
ble disease. The particular details will best ap- 
pear, by a reference to the individual cases report- 
ed in the next chapter. Before we proceed to 



\ 



126 TREATMENT OF THE FEVEK. 

them, however, it will be proper to make a few 
remarks upon some of the principal remedies, 
and the effects of their exhibition. 



VENESECTION. 

I mention venesection among the remedies for 
this disease, although I did not employ it myself, 
nor see any case in which it had been employed ; 
because it has generally been considered a pow- 
erful remedy, and because it gives me an oppor- 
tunity to say that I have had no experience of 
its efficacy. T was deterred from practising it, 
by the great tendency to debility which I wit- 
nessed in the disease, as well as by the reports 
which I had heard of the disastrous effects, which 
were said to have followed its use in other places. 
The foundation of these reports, or the accuracy 
with which they were related, it does not come 
within my plan to examine here. 

BLISTERING 

Blisters were remedies of very powerful effi- 
cacy in a variety of cases. In the first place, at 
the commencement of the disease, when there 
were symptoms of a pneumonic affection, pain 
in the chest, cough, and difficulty of breathing, 
a single blister applied as nearly as possible over 
the seat of the pain, was almost invariably effec- 



TREATMENT OF THE FEVER. 127 

tual in relieving them. In obstinate vomitings, 
where other means had failed, a blister applied 
on the left epigastrium was a very powerful aux- 
iliary. I also generally applied blisters to the 
back part of the neck, and upper part of the 
arms, in cases of deep and obstinate coma ; but 
I am less satisfied of their efficacy in these cases, 
than in any other in which I have ever prescrib- 
ed them. I have often had opportunity to wit- 
ness their effects, not only during the Epidemic, 
but in many other cases of coma in fevers, while 
the same constitution of diseases prevailed ; and 
have been led more and more to doubt their 
being of service, until I have altogether ceased 
to prescribe them for this symptom. 

There is still one other case in which blisters 
were applied with advantage in the Epidemic 
fever. Where the debility was very great, and 
a sort of languor and exhaustion of the vital 
pow r ers seemed to pervade the whole system, 
small blisters were frequently applied to the 
wrists and ancles with very good effect. For the 
last two or three years, when recommending blis- 
ters, for this purpose, I have usually directed 
the vesicating plaster to be removed, after the 
skin has become sensible to its action, before the 
blister is fully formed. The principal benefit to 
be derived from the application, in these cases, 
consisting in the excitement produced by the 



128 TREATMENT OF THE FEVER. 

action of the plaster, and not in the subsequent 
(discharge, we are able by this means to take ad- 
vantage of the excitement, and at the same time 
to avoid in a great measure, the inconvenience 
and pain which commonly follow. Another ad- 
vantage is, that by avoiding the disagreeable 
ulcers which full blisters often produce, we are 
able to repeat the application at pleasure, with 
very little suffering or inconvenience on the part 
of the patient. It was not until after the Epi- 
demic had disappeared, that I adopted this prac- 
tice. But as it was in cases perfectly analagous, 
it seems not unsuitable to mention it in this 
place. 

FOMENTATIONS. 

Fomentations are remedies somewhat similar in 
their nature and mode of action to blisters, 
though milder, and of course less efficient. For 
the removal of various local pains, particularly 
in the bowels, and sometimes in the back, I ofien 
found them very serviceable. In obstinate vo- 
mitings, I invariably tried their efficacy, be- 
fore resorting to blistering, and not unfrequently 
with success. In slight affections of the chest 
too, they were sometimes applied with benefit. 
The more usual mode of applying them, was to 
fold the leaves of some of the common bitter 
herbs, such as wormwood or tanzy, in flannel, 



TREATMENT OF THE FEVER. 129 

wet it in hot vinegar, or common spirit, and lay 
it upon the part affected. I shall not stop to 
inquire, whether any benefit could be derived 
from any medicinal virtues of the plants made 
use of. Certain I am, that a fomentation of this 
kind was more effectual, than one made by sim- 
ply wetting folds of flannel in vinegar or spirit, 
and applied in the same manner. 

FRICTIONS. 

Friction of the skin is another external appli- 
cation, which was often extremely useful. In all 
cases of severe coma, this was resorted to in aid 
of the more important internal remedies. In 
these cases, the friction was generally performed 
with flannel dipped in vinegar or spirit, and if 
there was much appearance of torpor, in a solu= 
tion of cantharides. For the relief of local 
pains, and numbness in the limbs, the friction 
was best performed with the naked hand, mois= 
tened with oil. Whether it was owing to any 
virtues of the oil itself, or that the friction was 
more perfectly executed, oily frictions were more 
effectual in relieving these kinds of pain, than 
those which were more stimulating. 

EMETICS. 

I have already observed, that when the fever 
had been preceded by symptoms of a derange- 

17 



130 TREATMENT OF THE FEVER. 

ment of the functions of the stomach, an emetic 
was particularly serviceable. In these cases, I 
generally gave the powdered ipecacuanha mixed 
with a watery solution of tartrite of antimony, 
in divided doses. In a few instances of this kind, 
the progress of the disease was nearly or quite 
arrested by the operation of the emetic. In other 
cases, however, where the stomach had not been 
previously disordered, no such benefit resulted 
from it ; but on the contrary, the debility was 
increased, and sometimes a troublesome and ob- 
stinate vomiting was occasioned by it. 

At a later period of the disease, when emetics 
were given in consequence of loss of appetite, 
loathing of food, &c. it was important that their 
operation should be speedy, and with as little 
subsequent nausea as possible. For this purpose, 
I gave a full dose of the powder of ipecacuanha 
in water, taking care to have no more liquid, than 
was necessary to facilitate the swallowing of the 
medicine. If this did not evacuate the stomach 
in a short time, an additional quantity was given ; 
or more frequently a small portion of sulphate 
of zinc was administered in its stead. In a few 
instances, where the stomach seemed unusually 
torpid, I gave sulphate of zinc with the ipecacu- 
anha at first, and more rarely by itself; and once 
or twice I made trial of sulphate of copper, to 
produce vomiting. The operation of the sul- 



TREATMENT OF THE FEVER. 13! 

phate of copper was so violent and unpleasant, 
that I shall hardly be disposed to repeat it, unless 
it were to become a matter of absolute necessity. 

The sulphate of zinc, though much less vio- 
lent, is also an extremely unpleasant remedy ; 
and it is only where it is very important to excite 
vomiting without continued nausea, and where 
ipecacuanha fails of doing it, that I should feel 
inclined to recommend it. I have once seen a 
pretty violent inflammation of the stomach pro- 
duced by its action ; and although in this case I 
am fully persuaded that the life of the patient 
was saved by administering it, yet the effects 
were sufficiently troublesome, to teach me much 
caution in prescribing it in future. 

CATHARTICS. 

The only object for which I ever prescribed 
cathartics in the Epidemic, was to obviate cos- 
tiveness. For this purpose, those were always 
preferred which would be the least likely to give 
pain in their operation, and would produce the 
least prostration of strength. A more frequent 
prescription than any other of this kind, was a 
pill composed of equal parts of aloes, rhubarb, 
and soap. Castor oil, was often given, especially 
to children, and powdered rhubarb not unfre- 
quently. Sometimes carbonate of potash was 



132 TREATMENT OF THE FEVER. 

mixed with the rhubarb, and an acid added ; and 
the whole given in a state of effervescence. 
When the debility was great, emollient injections 
were always preferred to cathartics administered 
by mouth ; and if the discharge produced by the 
enema alone was not sufficient, a small dose of 
some mild cathartic was given, and its operation 
aided by the exhibition of an enema. 

In some of these ways, if not by the spontane- 
ous action of the organs concerned, a discharge 
was generally procured every day, or every sec- 
ond day ; although in some few instances a cos- 
tiveness was suffered to continue longer, without 
any manifest inconvenience. A very considera- 
ble degree of exhaustion, and prostration of 
strength frequently followed the operation of the 
mildest cathartic or enema, and was sometimes 
produced even by a spontaneous and apparently 
healthy discharge. This was however in general 
easily removed, by seasonably administering 
cordials and tonics. 

DIAPHORETICS. 

I prescribed a considerable variety of dia- 
phoretics, at different times during the prevalence 
of the Epidemic, but preferred such as produced 
their effect when administered in small quanti- 
ties, and at the same time, had little tendency to 



TREATMENT OF THE FEVER. 133 

create a nausea, or to increase the debility and 
exhaustion of the patient. I sometimes gave 
the powder of ipecacuanha and opium, of the 
pharmacopoeia ; but the bulk occasioned by so 
large a quantity of sulphate of potash, rendered 
it difficult to administer it in sufficient doses, 
without its oppressing the stomach ; especially 
where there was a strong tendency to vomiting. 
On this account, I occasionally prepared it with 
a much smaller proportion of the sulphate. 
This preparation was preferable to the other; 
but was not equal to one in which camphor was 
conjoined with ipecacuanha and opium, in the 
proportion of one part of opium, to two of cam- 
phor, and three of ipecacuanha, triturated togeth- 
er. This powder, given in as large doses as the 
patient could bear without nausea, rarely failed 
of exciting perspiration in a short time ; and by 
repeating it once in four hours, in smaller doses, 
proportioned to the exigencies of the case, it was 
generally easy to regulate the evacuation almost 
at pleasure. 

Being at one time, for several days, destitute 
of ipecacuanha, I substituted the antimonial pow- 
der, and in a few instances tartrite of antimony, 
for it in the compound powder. Neither of these 
articles answered the purpose so well as ipecacu- 
anha ; but the latter was the most objectionable 
of the two. They occasioned too much nausea, 
and increased the sensation of faintness at the 



134 TREATMENT OF THE FEVER. 

stomach, and Ave re more liable to be rejected by 
vomiting. The same objections were applicable 
to the antimonial powder given alone, besides 
that it was less certain to produce the beneficial 
effects, for which diaphoretics were prescribed. 

It was upon the compound powder of ipecac- 
uanha, opium, and camphor, therefore, that I 
principally relied, to produce the diaphoresis, 
which was regarded as the first step towards the 
cure of the fever under consideration. This was 
generally given, except at the commencement of 
some very severe cases, in doses, which were 
repeated every four hours, until the cure was so 
far advanced that the skin began to resume its 
healthy functions, when it was given less fre- 
quently,andwas gradually discontinued. For chil- 
dren, I very commonly added half a grain or a 
grain of submuriate of mercury to each dose of 
the powder. The same thing was done in a few 
instances for adults, especially in cases of a pneu- 
monic affection, but it was by no means a gene- 
ral practice. Finding the fever to be manage- 
able by other means, I wished to avoid the incon- 
venience and risk of a salivation, so long as it did 
not appear to be necessary. 

These means for inducing perspiration were 
aided, in all severe cases at least, by applications 
made to the surface of the body. The patient 



TREATMENT OF THE FEVER. 135 

commonly, though not universally, bathed his 
feet in hot water before going to bed. He was 
then covered with as many clothes as he could 
comfortably support ; and generally, a sort of va- 
pour bath was produced in his bed. Bricks 
were heated and rolled up in a damp cloth, or 
brands from the fire, or billets of porous wood 
boiled in water, were prepared in the same man- 
ner, and placed around him in the bed. Bottles 
of hot water were sometimes used for the same 
purpose. These applications were frequently 
made by the attendants, before the arrival of a 
physician. But except in very slight cases, the 
relief produced by them was never very com- 
plete, although a sufficiently profuse perspira- 
tion was often excited. 

The appearance of a diaphoresis was very 

much facilitated by the warm aromatic drinks 

which were taken, to remove the thirst. The 

quantity of these was sometimes very great. In 

the early part of the disease when the thirst was 

the most urgent, I generally suffered the patient 

to regulate the quantity, by his own feelings. He 

was never, by my directions, urged to drink 

more, on account of the diaphoresis, than his 

.thirst required. I make this remark because it 

seems to have been supposed by some, that the 

object was to fill the stomach with as many hot 

and stimulating liquids, as could be forced into it. 



136 TREATMENT OF THE FEVER. 



STIMULANTS. 



Cinchona. Tonics, narcotics, and cordials were 
all of them, used at some part of the sickness, 
and not very rarely through the whole course 
of it. Of the tonics, the most generally and con- 
stantly useful, was the cinchona ; especially when 
it was combined with orange peal and serpentaria 
in the fermented decoction already described, 
and in the compound tincture. In a few instances, 
I gave a simple infusion or decoction of cincho- 
na, but it was only when for some particular 
reason, the compound could not be administered. 

Whenever a tonic of any kind was indicated, 
at whatever period of the disease, it very rarely 
happened that the fermented decoction could 
not be given with manifest advantage. It was 
sometimes, but not often, rejected during the 
vomiting stage, when a more simple bitter, such 
as quassia, would stay upon the stomach. In a 
few cases also, it was necessary to omit it on ac- 
count of an idiosyncracy of the constitution, 
which prohibited the exhibition of cinchona in any 
form. Yet this decoction was often received 
by persons who could not take that tonic in any 
other preparation. It was more grateful to the 
palate of most persons, was less liable to occa- 
sion strictures of the chest, and had less tenden- 
cy to produce or increase a febrile excitement 



TREATMENT OF THE FEVER. 137 

in the system, than any other composition of the 
kind, which I have ever seen administered. 

If there were any considerable symptoms of 
reaction in the system ; that is, if the pulse was 
full, or if there were perfect chills, succeeded by 
heat ; and especially, if there were symptoms of 
an affection of the lungs, the decoction of cincho- 
na was not given until these symptoms were, at 
least in some degree, removed by other reme- 
dies. In other cases, it was prescribed at the 
first visit, and administered as soon as it could be 
prepared ; and in all cases it was administered as 
soon as the second, or at the latest, the third 
day. The dose prescribed, of course varied ac- 
cording to the circumstances of the case ; but 
was commonly for adults about the amount of a 
wine glass full, repeated every four hours. Dur- 
ing the vomiting, like every thing else, it was 
given in much smaller quantities at a time, and 
oftener repeated, and sometimes was discontinu- 
ed. After the vomiting had subsided, however, 
as large quantities were given as before. 

This decoction was not unfrequently continu- 
ed, until the patient was so far recovered as to 
leave off the use of tonics altogether. More 
commonly, however, especially in severe cases, 
as soon as the patient began to have a relish for 
solid food, the compound tincture of cinchona 

18 



138 TREATMENT OF THE FEVER. 

was preferred to the decoction, and took its place 
in the prescription. The tincture was also occa- 
sionally given earlier in the disease. Sometimes 
both preparations were given at the same time, 
at intermediate hours ; and sometimes thev were 
prescribed alternately, on different days, as the 
patient became tired of one or the other. The 
more common dose of the tincture was the usual 
one of a drachm. It was generally given in a 
little brandy and water, either heated or not, 
according to the feelings and wishes of the pa- 
tient. If he was feeble and exhausted, the effect 
was more salutary as well as more pleasant, to 
have it as hot as he could well drink it ; at 
other times it was given cold. 

Gentian.— Whenever any peculiar idiosyncracy 
of constitution rendered it difficult or impossible 
to give the tincture of cinchona, the compound 
tincture of gentian was substituted for it. A 
fermented decoction similar to that of cinchona, 
was also some few times prepared and given in 
these cases. It was a useful tonic, but being less 
powerful and less certain in its effects than cin- 
chona, it was only given when that could not 
be. During the convalescence, the tincture of 
rhubarb and gentian was often prescribed, to ob- 
viate costiveness ; and with very good effect. 



TREATMENT OF THE FEVER. 139 

Uuassia. — Quassia was extensively useful as a 
tonic in this disease. In almost all cases in which 
from whatever cause, cinchona could not be ad- 
ministered, the infusion of quassia was given as a 
substitute. In the early part of the disease, when 
the cinchona would be likely to produce too 
much excitement, and yet it was desirable to 
give something* to prevent the strength of the 
patient from sinking, this was a remedy exactly 
suited to the wants of the case. In some cases of 
coughs, which forbad the use of more powerful 
tonics, it was also extremely useful. During the 
vomiting stage of the fever, quassia often remain- 
ed on the stomach, when almost every thing else 
was rejected ; and was therefore very frequently 
prescribed at that time. Besides these several 
cases, it was often given at intermediate hours, dur 
ing the exhibition of other tonics, especially when 
the patient was very low ; and aided very much 
in producing the effect desired. The quantity 
prescribed was not very precisely limited. I 
commonly ordered a spoonful of a strong infu 
sion to be given every hour. 

A variety of other vegetable tonics was oc- 
casionally prescribed ; but their effects were not 
so peculiar as to require a particular notice. 
Those of the serpentaria and orange peal have 
been sufficiently described, when speaking of the 
compounds into which they always entered 



140 TREATMENT OF THE FEVER. 

whenever they were prescribed. Of the others, 
chamomile flowers, cascarilla, and colomba were 
more frequently ordered than any others. They 
generally fulfilled the intention for which they 
were prescribed, with about the same constancy 
as in other diseases. 

Acids. — The aromatic sulphuric acid was fre- 
quently given, especially during the convales- 
cence. It was generally combined with the com- 
pound tincture of cinchona, and seemed some- 
times to prevent the tincture from disagreeing with 
the constitution. In a few low cases, the muriatic 
acid was given in small quantities, with other 
tonics. 

Metallic Tonics. — The only metallic tonics 
of which I made any use during the Epidemic, 
were arsenic and iron. The arseniate of potass 
was the only preparation of the former ever given. 
In two or three of the first cases, it was given in 
doses of three or four drops, mixed with an equal 
quantity of tincture of opium, repeated every four 
hours, and apparently with very good effect. But, 
having lost a patient early in the season, in conse- 
quence of the carelessness of a nurse, who mistook 
the arseniate for something else, and gave a large 
quantity, I abandoned its use altogether ; not so 
much from a dislike to the remedy itself, as from 
a want of confidence in the care with which it 
would be administered. 



TREATMENT OF THE FEVER. 141 

Iron, whenever it was prescribed, was given 
with myrrh, as in Griffith's Myrrh Mixture, or 
his Myrrh Pills, prepared according to the for- 
mulas in Thatcher's Dispensatory. It was rarely, 
if ever given early in the disease. But after the 
cure had made some progress, and especially in 
cases of protracted convalescence, its effects w T ere 
often very salutary. The quantity prescribed was 
regulated by the circumstances of the disease, and 
of course varied very much in different cases. 

Wine. — Wine in its simple state was made use 
of, only in a few instances, and then generally to- 
wards the close of the convalescence. It very rare- 
ly agreed well with the stomach, and was not com- 
monly grateful to the taste. Sometimes it occa- 
sioned vomiting, and oftener, acidity and oppres- 
sion. Wine whey was much more frequently 
taken with relish, though rather as an article of 
diet than of medicine. 

Brandy. — This article was very frequently 
given ; and sometimes in pretty large quantities. 
Much reliance was placed upon its good effects, 
in concurrence with other tonics, whenever the 
strength was very low, and particularly in cases of 
great faintness and a sensation of sinking. It was 
given at irregular intervals, and in very different 
quantities, according to the situation of the patient. 
The proper time for administering it, was gene- 



142 TREATMENT Oi- THE FEVER. 

rally not until a perspiration had commenced, 
and the more violent symptoms of the access had 
begun to subside. In some few cases, however, 
where the prostration of strength, and the appa- 
rent depression of the vital powers, were extreme, 
I did not wait until these changes had taken place. 
Indeed it not unfrequently happened, in ordinary 
cases, that brandy was given at the commence- 
ment of the disease, before the arrival of a phy- 
sician. But it was not prescribed in such cases, 
and when taken, was many times rather injurious 
than beneficial in its effects. 

It is worthy of remark that those who had 
been accustomed to a free use of spiritous liquors 
when in health, generally took them with much 
less relish, when sick with the fever, than others 
whose habits were more temperate. 

The brandy was either mixed with aromatic 
drinks, or was diluted w T ith water, as the patient 
preferred. The degree of dilution was also prin- 
cipally regulated by the feelings and choice of 
the sick. In most instances it was more pleasant, 
as well as more useful, when given as hot as 
could easily be borne. This was particularly the 
case, when the sensation of faintness in the region 
of the stomach was urgent ; and still more so, 
when the object was to prevent vomiting. In a 
few cases of obstinate vomiting, a few tea-spoon- 



TREATMENT OF THE FEVER. 143 

fuls of brandy given at short intervals, very strong, 
and as hot as possible, were more successful in ar- 
resting this troublesome symptom than any thing 
else. It was a few times given pure, for this pur- 
pose, though in very small quantities ; and even 
rendered more active by the addition of cinna- 
mon or some other aromatic. This, however, was 
never continued more than for a very short period, 
at any one time. When its use was continued 
longer, it was freely diluted. 

In coma, brandy was sometimes given in large 
quantities, conjoined with tincture of opium. In 
these and some other cases, it was not unfrequent- 
ly mixed with yeast, with good effect. When 
there was a difficulty of swallowing a sufficient 
quantity, this mixture was given in an enema, 
taking care to add tincture of opium enough to 
ensure its retention. Alcohol in other forms was 
occasionally given, although rarely, and only 
when some peculiar circumstance rendered it 
impossible for the brandy to be taken. 

Opiates. — Opium in substance was given only in 
the compound diaphoretic powders. The simple 
tincture was given, whenever it was indicated for 
the purpose of checking diarrhoea. It was also 
frequently prescribed with some of the volatile 
oils, to remove a disposition to vomiting and faint- 
ness. But it was bv far the most liberally used 



144 TREATMENT OF THE FEVER. 

in cases of coma. Whatever may be the expla- 
nation of its mode of action, it is certain that this 
was a powerful agent in removing the deepest 
comas, which were not absolutely irrecoverable. 
For this purpose it was sometimes given in large 
quantities, both by mouth, and by injections. 
To allay irritation and promote rest, the campho- 
rated tincture of opium was frequently given at 
bed-time, and occasionally at other times, but al- 
ways in moderate doses. It was also frequently 
mixed with the volatile oils, in preference to the 
simple tincture, to excite the stomach. 

Cordials. — The more diffusible stimuli were 
resorted to, whenever the prostration of strength, 
or the torpor of the system seemed to require a 
speedy excitement. It has already been observed 
that the volatile oils were extensively used for this 
purpose. The carbonate of ammonia, either in 
powder or in a liquid state, was sometimes pre- 
scribed with the same intention ; besides a va- 
riety of other articles already mentioned. 

Diet. — It has already been remarked, that the 
diet was principally confined to the lighter articles 
of food. Simple soups made pretty strong, but 
with the oily parts separated, and seasoned to the 
taste of the patient, were preferred. When these 
disagreed, or could not readily and constantly be 
obtained, gruel, arrow root, sago, panada, and 



TREATMENT OF THE FEVER. 145 

other light vegetable articles,, were substituted 
for them. After the desire for solid food return- 
ed, which was generally rather early in the con- 
valescence, a much greater variety was permitted 
in the diet. The appetite for solid food in many 
cases commenced by an urgent desire for some 
particular article ; and this often not apparently 
very well suited to the condition of the patient. 
Unless, however, it would be manifestly injurious, 
the desire was generally satisfied. The food de- 
sired was given, at first with much caution, and 
very rarely produced any injury. 

Of the more common drinks, decoction of aro- 
matic vegetables, brandy, wine whey, &c. enough 
has already been said. Coffee was very generally 
taken with much relish, and without any un- 
pleasant effect. Cold water was allowed at the 
beginning of the disease, if the patient wished it; 
an occurrence which sometimes, though rarely 
happened. During the vomiting it was always 
injurious, and was therefore prohibited, although 
the thirst for it was sometimes very urgent. Dur- 
ing the convalescence it was not often desired, 
and was not denied, unless some peculiar cir- 
cumstance forbad its use. I saw one or two 
cases of a very singular raging thirst for cold wa- 
ter, for which I hardly know how to account, in 
which a very large quantity was taken without 
any disadvantage. A case of this kind with its 

19 



146 TREATMENT OF THE FEVEK. 

attending circumstances, will be given in the next 
chapter. 

During the convalescence, and sometimes ear- 
lier, cider was more generally desired than any 
other article of drink. It was very freely allow- 
ed, and produced no inconvenience, except that 
in a few instances, it occasioned a slight diarrhoea. 
When it could be obtained, bottled cider was 
always preferred. But as this was not always at 
hand, good draught cider was often taken. 



REGIMEN. 

The object which was principally kept in view 
in managing the regimen, was to render the pa- 
tient as comfortable as possible, and at the same 
time to secure a constant, but mild and equable 
perspiration. The temperature of the room, the 
quantity of bed-clothes, &c. were determined by 
this rule. It was considered important, that the 
temperature of the room should be as uniform as 
possible. The degree of warmth which is the 
most agreeable to a healthy person was nearly 
preserved. When it could conveniently be done, 
the patient lay in flannel sheets, and wore a bed- 
gown of the same material. Flannel was prefer- 
red to linen or cotton, as giving less exposure to 
chills from changes of temperature, or from the 
moisture produced by perspiration. 



TREATMENT OF THE FEVER, 147 

The bed was generally made every day. If, 
as was often the case, the patient was too feeble 
to sit up while this was done, he was lifted on to 
another bed ; and if his circumstances admitted 
of it, the bed-clothes, as well as his linen, were 
changed every day, or every second day. Con- 
siderable care was taken to have the room well 
ventilated. If it was small, a window was kept 
open nearly the whole time, taking care of course 
not to have the fresh air blow directly upon the 
patient. To effect this, where the window did 
not let down from the top, several folds of thick 
cloth were pinned closely at the bottom upon the 
casement of the window which was open, so as to 
give the air a direction upwards. 

The patient was allowed only very short periods 
of sleep, without being waked. The frequency 
with which it was necessary to give medicine or 
nourishment, in many cases caused his being wak- 
ed sufficiently often. If this did not require it, 
it was nevertheless important that he should not 
sleep more than from fifteen to thirty minutes at 
a time, according to the severity of the case, 
and especially according to the disposition to 
coma. When suffered to sleep too long, he was 
waked with more difficulty, and was evidently 
enfeebled and exhausted, rather than refreshed 
by it. 



148 TREATMENT OF THE FEVER. 

A considerable degree of inconvenience was 
suffered from the want of such medicines as were 
frequently desirable. I was often under the ne- 
cessity of prescribing differently from what I 
wished to do, because the article which I prefer- 
red could not be obtained. There was at that 
time no apothecary in town ; and in consequence 
of the difficulty of obtaining medicine from a dis- 
tance, which the war with Great Britain occa- 
sioned, the shops in the vicinity were much 
more imperfectly supplied than usual. Some of 
the inconveniences occasioned by this circum- 
stance will appear in the following chapter ; 
others are not noticed, because they did not ap- 
pear materially to affect the result of the different 
cases. 



CHAPTER. IV 



CASES OF THE EPIDEMIC. 



CASE I. 

February 11 th 9 1814. A. L. is an unmarried 
woman, aged about 25 years. Her health has 
usually been good; until within a few months past, 
it has been less vigorous than formerly. I was 
first called to-day. She was seized with pain in the 
bowels and diarrhoea more than a week ago, but 
has been better since the first attack. Her 
diarrhoea, however, continued, and she has, of her 
own accord, taken a dose of sulphate of soda, by 
which her strength has been very much reduced. 
She has kept her bed for the last three or four 
days. She now complains of great pain in the 
head and extreme dizziness ; constant vomiting ; 
strength prostrate ; great numbness of the ex- 
tremities ; skin has a puffy, cedematous feeling. 



150 CASES OF THE EPIDEMIC. 

Purple spots appear occasionally on her limbs. 
Her pulse is so feeble and quick, that it is count- 
ed with difficulty ; tongue covered with a dark 
coat. She was directed to take the powder of 
ipecacuanha, opium and camphor, which is de- 
scribed in the preceding chapter, every four 
hours, and between the times of taking it, to 
drink a wine-glass-full of the fermented decoction 
of cinchona. Four drops of arseniate of potass, 
with four of tincture of opium, were ordered to 
be given each time in the decoction. Small 
quantities of brandy and of strong soup were di- 
rected to be given in the intervals. 

February 12th. In the morning. Every symp- 
tom is worse. Only a trembling of the pulse can 
be perceived at the wrist. The stomach has re- 
jected every thing she has taken. Omit the 
powders, and the decoction. R Lavend. 01. Vol. 
gt. iv. Tinct. Opii gt. v. every hour, in a tea- 
spoonful of warm brandy and water. This pre- 
paration gives a very grateful sensation to the 
stomach. Give frequently a little brandy, spiced 
and warmed. Apply spiritous fomentations to 
the region of the stomach. 

Afternoon. Vomiting less urgent. Re-com- 
mence the diaphoretic powders, and decoction of 
cinchona, as directed yesterday. 



CASES OF THE EPIDEMIC. 151 

13th. Symptoms somewhat mitigated; but the 
stomach still rejects the decoction of cinchona. 
Substitute for it, a strong infusion of quassia : of 
which give a table spoonful every hour, except 
when the powders are administered, which are to 
be continued as before. As she has been two 
days costive, an emollient enema was ordered, 
which produced a free stool of a natural appear- 
ance. 

14th. Rather better. Continue the powders 
and the infusion of quassia. The enema was re- 
peated, and with the same result as yesterday. 
R Tinct. Cinchon. compos. $\. every four hours. 

15th. Still better. Continue the medicines. A 
moderate dose of rhubarb was ordered to obviate 
costiveness. 

From this time her health gradually improved 
until in a fortnight, she was able to sit up half an 
hour at a time, and to eat pretty well. Substan- 
tially the same course of medicine was pursued, 
until she was perfectly recovered. In the course 
of her convalesence, she was affected with a pain, 
apparently rheumatic, in her left arm, which was 
readily removed by frictions with compound 
tincture of soap. Her health was better after 
her sickness than it had been for a few month? 
before. 



152 CASES OF THE EPIDEMIC 

CASE II. 

Feb. 24th. — Mrs. S. a married woman aged 
about 30, of a vigorous constitution, and good 
general health. She complains of great pain in 
the head and dizziness, which have been so se- 
vere, as to confine her to her bed for the last 
two or three days ; sickness at the stomach ; 
thirst ; numbness of the limbs. Purple spots 
occasionally appear on the skin. Her tongue is 
much coated; pulse quick, but not remarkably 
feeble. These symptoms have been gradually 
making their appearance, and increasing for a 
week. She was ordered the Pul. Ipecac. &c. 
every four hours ; at bed time to take Tinct. Opii 
Camph. 31. ; to drink warm aromatic decoctions 
as her thirst required, and to take soup for food. 

Feb. 25th. Her headach and dizziness are dimin- 
ished, as well as the thirst ; numbness and pete- 
chiae gone. Continue the diaphoretic powders ; 
and between each dose, take a wine-glass-full of 
the fermented decoction of cinchona. As she is 
costive, take a portion of powdered rhubarb. I 
did not see her again. She recovered in a few 
days. 

case nr. 

Feb. 26th. — J. D. a boy eleven years old, was 
seized suddenly yesterday morning, with violent 



CASES OF THE EPIDEMIC. 153 

pain in the head and dizziness, nausea and vomit- 
ing. During the night he was in a perfect deli- 
rium. This morning the vomiting has stopped, 
and he is rational. He still complains of great 
pain and dizziness of the head; pain in the back 
and limbs ; a slight numbness of the extremities ; 
thirst for warm drinks ; sickness, and a feeling of 
depression at the stomach. His skin is dry ; 
pulse quick, and tolerably strong, and his tongue 
much coated. The bowels are not apparently 
disordered. He was ordered the powder of 
Ipecac. &c. every four hours, to take warm aro- 
matic drinks ; and if these should not be suffi- 
cient to produce a diaphoresis, to make use of 
external sudorifics. If restless at night, he is to 
take a full dose of camphorated tincture of opi- 
um. Nourish with good soup. 

21th. — He has rested well through the night. 
The dizziness and pain in the head are much less 
severe than yesterday ; vomiting nearly ceased ; 
thirst and numbness diminished. Continue the 
Pul. Ipecac. &c. Take the fermented decoction 
of Cinchona between each powder, 

28th. — Much better ; every symptom reliev- 
ed ; has sat up more than an hour. His appe- 
tite has returned ; and he complains of nothing 
but debility. Continue a diaphoretic powder, 
night and morning ; and the fermented decoc- 
20 



154 CASES OF THE EPIDEMIC. 

tion, and a little brandy occasionally. I visited 
him no more. In nine days from this time he 
attended school in good health. 

CASE IV. 

Feb. 26th. — S. C. a healthy boy six years old, 
was seized last night with the usual symptoms; 
pain in the head and dizziness ; nausea ; tongue 
coated; skin dry; pulse rather fjuick, but not 
particularly feeble. R PuJ. Ipecacuan. gr. x. Sub- 
mur. Hyd. gr. viii. immediately. After the 
operation, give Pul. Ipecac. &c. every four hours. 
The medicine operated favorably ; and he requir- 
ed no more, except some rhubarb to open his 
bowels. In a few days he was as well as usual. 

case v. 

Feb. 26th. — S. L. a sister of A. L. Case I. about 
eighteen. She began to be a little ill three days 
ago, after rinsing clothes in cold water in the open 
air. This exposure occasioned a suppression of 
the menses, which had just commenced. She was 
not so sick, however, as to consult me, though I 
was every day in the house. She now complains 
of pain in the head and dizziness; loss of appe- 
tite, nausea, &c. ; but these symptoms are not so 
severe, but that she can sit up considerably. Her 
bowels are in good order, except that they are a 



GASES OF THE EPIDEMIC. 155 

little inclined to costiveness. R Pul. Ipecac. &c. 
every four hours. 

21th. — Worse ; beadach and dizziness increas- 
ed ; complains much of nausea ; vomits frequent- 
ly; skin dry the most of the time; has some 
degree of numbness ; extremities have a lifeless, 
oedematous feeling; costive. R Pul. Rhei gr. 
xxv. immediately. Continue the Pul. Ipecac. 
&c. every four hours; and give a table spoonful 
of infusion of quassia every hour. 

28/fe. — Pain in the head diminished ; vomiting 
less ; skin moist ; the rhubarb has not operated. 
Having no ipecacuanha, I subsituted the common 
antimonial powder for it in the composition with 
opium and camphor, and ordered it to be continu- 
ed as before. Continue also the infusion of quas- 
sia. R Pul. Rhei gr. xv. and in two or three hours 
after, administer an enema. 

March 1st. — Has rested well through the night ; 
vomits occasionally a little mucus ; numbness 
mostly gone ; feels very little pain ; skin tolera- 
bly moist ; is much inclined to sleep. The ene- 
ma produced a natural looking stool. Repeat it 
towards evening. Continue the Pul. Ipecac. &c. 
every four hours ; and in each interval give a 
wine-glass- full of the fermented decoction of cin- 
chona. Apply a blister to the upper arm. Give 



156 CASES 6t THE EPIDEMIC. 

brandy and well seasoned soup freely. Mem. 
The nurse is negligent, and the house terribly 
noisy. 

2d. — A little better, but is still very feeble ; ha9 
turns of faintness; pulse fuller, and less frequent; 
has very little thirst ; the enema last evening pro- 
duced a scanty evacuation of the bowels ; the skin 
is somewhat moist, though not constantly so ; she 
takes soup sparingly. Her nurse frets her. Con- 
tinue the Pul. Ipecac. &c. as before. R Tinct. 
Cinchon. Compos. 5i. every four hours. When- 
ever she is faint, give Spiritus Menth. pip. gt. 
viii. with Tinct. Opii Cam ph. gt. xx. 

3c?.— The symptoms are much the same, but a 
little better, though the amendment is not very 
considerable. Her menses have returned, and are 
sufficiently moderate. Continue the powder. 
Give a wine-glass-full of the fermented decoc- 
tion of cinchona every four hours; and at least 
an equal quantity of wine, during each interval. 
In the decoction give every time, arseniate of 
potass and tincture of opium, of each four drops. 

Ath. — Appears much as yesterday; is said to 
have had a good night ; pulse tolerably good ; in- 
clines to coma ; bowels sufficiently open. Con- 
tinue the medicines ; but pursue the stimulants 



CASES OF THE EPIDEMIC. 157 

more vigorously. Apply a blister to the upper 
part of the other arm. 

5th. — Much worse; was very much worried 
last night by her attendants, Her puise is low 
and quick ; tongue black ; protruded with diffi- 
culty ; a black sordes collects on the teeth ; ex- 
tremities feel puffy. She speaks indistinctly, and 
is inclined to faintness. I now discovered more 
particularly, what I had before partly known, 
that she is neglected and ill treated by her niirse, 
who is ill-tempered, petulant and noisy. I en- 
joined the strictest rest and quiet. Continue the 
Pul. Ipecac, &c. every four hours. Give half a 
drachm of compound tincture of cinchona, every 
two hours ; infusion of quassia a table spoonful 
every hour, brandy at least an equal quantity 
every hour ; and peppermint with camphorated 
tincture of opium as before, whenever she is faint* 
Nourish with good soup. 

6th. — Has rested considerably. Her pulse is 
better; tongue more natural; bowels in good or- 
der; skin moist. Continue the medicines; but 
do not pursue the more diffusible stimuli, quite 
so vigorously. At bed-time give a drachm of 
camphorated tincture of opium. 

1th. — Has been troubled with diarrhoea in the 
night, accompanied by a great disturbance of the 



158 CASES OF THE EPIDEMIC. 

bowels. Her pulse is lower and quicker; tongue 
and mouth extremely dry and parched ; she speaks 
with difficulty, and almost unintelligibly ; pro- 
trudes the tongue but little, and with great diffi- 
culty ; lips and teeth collect a black sordes ; skin 
moist; has turns of faintness. If the diarrhoea 
continues, give ten drops of tincture of opium 
after every stool. Continue the diaphoretic pow- 
der. Give a wine-glass-full of the fermented de- 
coction of cinchona every two hours, and other 
stimulants freely. 

Evening, — Has had no passage from the bowels 
since morning ; breathing laborious ; pulse pretty 
full, 140 in a minute. Apply a blister over the 
sternum. Give the decoction only half a glass in 
two hours. At bed time give Tinct. Opii Camph. 
5i. and whenever she is faint, give peppermint 
and camphorated tincture of opium as before. 

8th. — Has again been troubled with diarrhoea 
in the night, though less than before; pulse 140, 
less full. Continue the medicines ; but give more 
brandy. 

Evening. — Much the same. Has had one dis- 
charge from the bowels to-day. Apply a blister 
to the calf of each leg. 



CASES OF THE EPIDEMIC. 159 

9th. — No better, but grows weaker. I have 
at length discovered many instances of extreme 
bad conduct on the part of the nurse, and after 
much difficulty have succeeded in getting her 
discharged ; although the new one does not seem 
entitled to much confidence. IVly patient has still 
some diarrhoea, pulse 140, feeble; tongue ex- 
tremely parched ; lips and teeth covered with a 
black sordes; skin continues moist; respiration 
difficult; partially in a delirium. Continue the 
medicines as before, except to substitute the com- 
pound tincture of cinchona, one drachm every 
two hours, for the decoction. 

Evening. — Much the same. R Spiritus Menth. 
Pip. gt. viii. Tinct. Opii Camph. gt. xv. every 
two hours. 

10th. Case almost desperate ; tongue parched 
and black ; she is unable to thrust it out of her 
mouth; respiration laborious; delirious ; pulse 
low, quick and fluttering ; feet and legs swelled ; 
diarrhoea very urgent through the day, stools 
sometimes passed involuntarily ; fceces black, and 
extremely fetid ; great disturbance in the bowels ; 
swallows with difficulty ; refuses soup. Apply a 
blister over the cartilages of the lower ribs on 
each side. R Lavend. 01. Yol. gt. ii. Spir. Menth. 
Pip. gt. vi. Tinct. Opii gt. iv. every hour. Give 
fifteen drops of tincture of opium after every 



160 CASES OF THE EPIDEMIC, 

stool, until the diarrhoea is checked ; infusion of 
quassia, a spoonful every half hour ; a spoonful 
of brandy at least as often ; Tinct. Cinchon. Com- 
pos, occasionally, as she is able to receive it. 

Evening. — She seems a little revived. She now 
takes a little soup ; swallows better. Omit the 
tincture of cinchona, and give brandy every 
twenty minutes ; other things as before. 

\Mh. — Somewhat revived; pulse better; tongue 
more moist ; delirium less complete ; speaks bet- 
ter than she did yesterday, though still almost 
unintelligibly ; swelling of the bowels less, that of 
the feet and legs gone ; diarrhoea continues ; 
stools black and fetid. Continue the tincture of 
cinchona, and infusion of quassia, as directed yes- 
terday. After every stool, give tincture of opium 
ten drops. 

Afternoon. — Diarrhoea somewhat diminished ; 
stools less offensive. Give only five drops of the 
tincture of opium after each discharge. At bed- 
time give twenty-five drops of the same tincture. 

I discovered to-day that the nurse had mistaken 
the phial containing arseniate of potass and tinc- 
ture of opium (which were mixed in equal quan- 
tities) for that which contained the camphorated 
tincture of opium, and that for several days past, 



CASES OF THE EPIDEMIC. 161 

she had generally, if not always, given the former 
composition when the latter had been prescribed. 
I had been very particular in cautioning her 
against such a mistake, and in warning her of the 
fatal consequences, that would result from it. 

The two phials were so dissimilar in their ap- 
pearance as to be readily distinguished from each 
other ; but she seems to have transposed them 
in her mind, so as to mistake the one which she 
was to avoid. When the nurses were changed, the 
first repeated my cautions to the new one, but 
appears to have applied them to the wrong phial. 
I say this appears to have been the case, for there 
is so much falsehood and contradiction between 
them, that it is difficult to ascertain the truth. 
The arseniate of potass has not been prescribed 
for a week past, and had so passed out of my 
mind, that it did not occur to me, that it could 
be the cause of the bad symptoms, which I have 
detailed in the patient, until, on looking over the 
medicine to-day, I found that it was gone. As 
soon as I discovered what had been done, 1 or- 
dered as much carbonate of soda to be put into 
all her drinks, as they would bear without render- 
ing them very nauseous, and continued other 
things as before, 

V2th. — Seems better; has slept considerably 
last night; her delirium is less ; pulse one hun 

21 



162 CASES OF THE EPIDEMIC. 

dred and thirty, and fuller; tongue and mouth 
more moist and natural ; the tongue is still pro- 
truded with difficult v ; skin moist; respiration still 
laborious ; coughs considerably, and expectorates 
with ease, so far as to raise the matter into her 
mouth, but cannot spit it out. It is wiped out 
with a cloth by the nurse. The swelling of her 
bowels is gone ; diarrhoea moderated ; stools 
more natural in their appearance. She still has 
turns of faintness. Continue the tonics as before. 
At bed-time give a drachm of camphorated tinc- 
ture of opium ; and whenever she is faint, give 
fifteen drops of the same tincture with eight of 
spirit of peppermint. She is desirous of cider, 
which is to be freely allowed her. Continue the 
soda. 

1 3th. Morning. — Appears considerably better ; 
has rested pretty well ; pulse one hundred and 
thirty, pretty strong and full ; countenance more 
natural; breathes more easily; delirium less; 
speaks better; swallows more readily. Con- 
tinue the medicines. 

Evening. — The house has been very noisy 
through the day, and ihe patient is worse. Her 
pulse is quicker and smaller. She is much de- 
ranged; unwilling to lie in bed ; talks much, and 
incoherently of children jumping in the room ; is 
frequently faint; and has turns of trembling. 



CASES OF THE EPIDEMIC. 163 

Her tongue and skin are more dry ; respiration 
very laborious; diarrhoea less than it was yester- 
day. Continue the quassia, brandy and pepper- 
mint as before directed. R Pul. Ipecac. &c. 
every four hours ; the fermented decoction of cin- 
chona, hasf a wine-glass-full every two hours ; 
Tinct. Opii Cam. 3L at bed-time, to be repeated in 
two hours, if she continues restless. 

14Lth. — The first part of the last night, she was 
very turbulent ; but towards morning became 
more quiet, and slept considerably. She is now 
much as she was yesterday morning ; takes her 
medicine and soup well ; she asked for a bit of 
dry biscuit, which was given her, and she ate a 
little of it. The diarrhoea is not troublesome ; 
trembling continues. Continue the medicines as 
before. If her delirium should increase during 
the day, give her a drachm of the camphorated 
tincture of opium. 

Evening. — She has had one quite restless turn, 
but it did not continue long. The camphorated 
tincture was given as directed, and relieved her. 
She has grown tired of the fermented decoction, 
and takes it unwillingly. Substitute the com- 
pound tincture of cinchona, a drachm every two 
hours. 

\bth. — Last night she has slept pretty well, and 
to-day is better. Her tongue is considerably moist ; 



164 CASES OF THE EPIDEMIC. 

countenance improves ; trembling diminished ; 
diarrhoea continues moderately. She still speaks 
with difficulty ; coughs considerably, and expec- 
torates freely. She takes considerable cider with 
relish. Continue the medicines. 

1 6th. — Has had a tolerable night ; countenance 
more natural ; appetite improves ; trembling less ; 
feeling of faintness gone ; coughs and expecto- 
rates considerably ; complains of sore throat ; 
bowels nearly regular. R PuL Ipecac. &c. every 
six hours. Continue other medicines as before. 
Make an infusion of flaxseed, and give a little 
frequently. 

17th. — Continues to improve gradually. Her 
tongue has a more natural appearance. She speaks 
distinctly, and with her usual tone of voice ; res- 
piration easier ; expectoration copious and free ; 
possesses her mind more completely than for 
some time past; has still a slight trembling; 
diarrhoea continues slightly. Take every hour 
ten drops of the camphorated tincture of opium 
in the infusion of linseed. Continue other medi- 
cines as before. 

18/^. — Rested well in the night ; has had no dis- 
charge from the bowels since yesterday morning, 
when she passed a natural stool ; pulse one hun- 
dred and thirtv, rather hard, and stronger than 



GASES OF THE EPIDEMIC. 165 

lately ; tongue dry and black ; mouth dry ; thirst 
increased ; appetite for food improved ; trembling 
continues, perhaps increased ; no faintness ; skin 
moist ; speaks with more difficulty ; respiration 
rather more laborious ; cough loose ; expectora- 
tion copious and free ; had last night a paroxysm 
of delirium, and again this morning, but they 
were of short duration. 

I learned to-day that she has for four or five 
days, had an ulcer on her right hip. It is not large, 
and does not in any respect appear very badly. 
It discharges a little, and appears sufficiently, 
though not remarkably sensible. I could pass 
the probe, in one direction about an inch under 
the skin. I dressed it with Emp. Resin. R Pul. 
Ipecac. &c. every four hours. Tinct. Cinch. 
Comp. 31. every hour; at bed-time Tinct. Opii 
Camp. 3i. and put into all her common drinks as 
much soda as the taste will permit. Give cider 
freely, and brandy according to the degree of 
exhaustion and debility. 

19/A. — Is less distressed ; tongue more moist; 
expectoration continues to be free ; skin gene- 
rally moist, although it was dry for a short time 
when I was present. The pulse was then one 
hundred and fifty, and she was more distressed ; 
respiration rather laborious; has passed three 
stools since yesterday morning. A slough as 



166 CASES OF THE EPIDEMIC. 

large as a nine-penny piece is separating from the 
ulcer on her hip. Apply to it a mixture of flour 
and honey. ft Pul. Ipecac. &c. as before. 
Tinct. Cinch. Com. 31. every hour, unless the ex- 
pectoration should be checked, or some other dis- 
agreeable symptom should be produced by it; 
brandy freely and iiberally ; at bed-time Tinct. 
Opii Cam. 3L 

Evening. — Has been much distressed, vomited 
and is in some degree relieved, still, however, 
seems distressed ; respiration laborious ; speaks 
with difficulty ; lies in a partial stupor, from 
which however, she is easily roused ; pulse one 
hundred and thirty ; tongue more natural in its 
appearance ; skin moist. Omit the tincture of 
cinchona. R yeast and brandy, at least a table- 
spoonful of each mixed together every hour, unless 
it should oppress her ; brandy besides, liberally ; 
a strong infusion of quassia, a tea-spoonful every 
half hour ; Lavend. 01. Vol. gt. ii. Spir. Menth. 
Pip. gt. vi. Tinct. Opii gt. xii. every hour. Con- 
tinue the Pul. Ipecac. &e. as before, and at bed- 
time give Tinct. Opii Cam. 3i. 

20th. — Lies in a stupor, from which nothing will 
rouse her. Aqua Ammoniae was given her for 
this purpose, but without any perceptible effect ; 
respiration short, slow and laborious ; pulse 160; 
skin moist ; had one discharge from the bowels in 



CASES OF THE EPIDEMIC. 167 

the night, before which they were much swollen, 
and afterwards less. Expectoration ceased about 
1 o'clock in the morning. About 10 A. M. she 
ceased to swallow, and about twelve expired. I 
earnestly sought permission to examine the body, 
but could not obtain it. 

It may perhaps be thought, by some, that the 
symptoms in this case, ought at an earlier period, 
to have led me to suspect, that arsenic had been 
given. But it should be remembered that the 
Epidemic to which this disease belonged, assum- 
ed almost every possible variety of appearance; 
so that an unusual symptom was not an object of 
suspicion, as it would have been at any other time. 
The use of arsenic had been so long discontinued, 
that it had passed out of my mind ; and as I was 
continually witnessing anomalous symptoms for 
which I could not account, in other cases of the 
same disease, it did not occur to me as the cause 
of those I observed in this. Besides I was con- 
stantly perplexed by the contradictory accounts 
given me by the nurse, and other members of the 
family. Those of the family who were the most 
capable of taking care of a sick person, w^ere 
too ill themselves, or too much occupied by fam- 
ily concerns, to attend to the immediate manage- 
ment of the sick bed ; so that the patient was left 
almost exclusively to the care of a nurse, in whose 
veracity I had very little confidence. It was 
therefore difficult to ascertain the real situation 



168 CASES OF THE EPIDEMIC. 

of the patient, except from the observations which 
I could make my self during mv visits; and these 
visits were necessarily very short, in consequence 
of the multiplicity of other engagements which 
the Epidemic occasioned. If I had been able to 
examine the medicines daily, as I usually did. when 
I had sufficient leisure, and to inquire more par- 
ticularly into every circumstance of the case, I 
should doubtless have discovered the mistake 
sooner. But as it was, I saw that the nurse was 
petulant, noisy and negligent, and I imputed to 
her neglect and mismanagement, the bad symp- 
toms which were but too apparent. This opinion 
was strengthened by observing some improvement 
in the condition of the patient, for the first day 
or two after the nurse was changed. 



CASE VI. 

Feb. 26//*.— Mrs. H. about forty years old- 
has latelv been considerablv exhausted bv attend- 
ins upon a sick child. She was violently attack- 
ed to-day with severe pain in the head and dizzi- 
ness ; pain in the back and limbs ; occasional 
Tomitino; ; thirst for warm drinks. Her pulse is 
quick and hard ; tongue coated ; skin dry. She 
complains of a severe, and acute pain in the tho- 
rax under the rieht breast, which occasions diffi- 
culty of breathing. She has been for several 
days subject to a cough, accompanied by a : 



CASES OP THE EPIDEMIC. 169 

expectoration, both of which continue. Apply a 
blister, as nearly as possible, over the seat of the 
pain in the chest. R Pul. Ipecac. &c. every 
four hours; and at bed time, Tinct. Opii Cam. si. 

21th. — Has rested pretty well, during the night. 
The pain in the chest is somewhat mitigated, parti- 
cularly while the body is at rest, but is still se- 
vere upon motion. Pulse quick, but feeble ; 
vomiting rather less urgent. Continue the Pul. 
Ipecac. &c. and to each powder add one grain of 
Sub-muriate of mercury. As she is costive, give 
Pil. Aloes and Rhei as much as is sufficient to 
move the bowels. N. B. These pills are made 
of equal parts of aloes, rhubarb, and soap. 

28/^.— Has passed a quiet night; and every 
symptom is relieved. The pills produced a mod- 
erate dejection. Continue Pul. Antimon.^ &c. 
as she has taken the powder of Ipecac. &c. and in 
each interval, take a wine-glass-full of the ferment- 
ed decoction of cinchona. 

March 1st. — Has had a good night, and is bet- 
ter ; pain in the thorax mostly gone ; vomiting 
ceased; has no pain in the head, nor dizziness; 
skin moist; expectorates freely ; bowels regular; 
likes the fermented decoction much. Continue 
it. & Pul. Ipecac. &c. every six hours. 

* The antimonial powder in this composition was used as a substi^- 
tnte for ipecacuanha, with camphor and opium. 

22 



170 CASES OP THE EPIDEMIC. 

2d. — Better in every respect ; bowels regular ; 
expectoration free ; pulse of natural frequency, 
but feeble ; vomiting and thirst gone ; skin na- 
tural in its appearance ; has but very little ap- 
petite for food. Be Pul. Ipecac. &c. night and 
morning ; Tinct. Cinchon. Compos. 3i. every 
four or five hours. 

3d, — Is nearly recovered ; feels pretty well, 
except that she is feeble ; has some appetite for 
food ; sleeps well ; pulse pretty good ; bowels 
regular ; tongue moist, coat nearly separated. 
Continue the Tinct. Cinchon. Compos. If at any 
time a paroxysm of fever should return, take a 
powder of Ipecac. &c. 

She recovered without any further attendance. 
In the course of her convalescence she was affect- 
ed with a pain apparently rheumatic, in her shoul- 
der, which was speedily removed by friction with 
01. Ammoniatum. 



CASE VII. 

Feb. 27th. — Mr. W. a vigorous healthy man, 
about 30 years old. He has walked, or rather 
skaited upon the ice, two miles to-day to attend 
meeting, attended two services, and returned in 
the same manner. He began to feel rather ill be- 
fore he reached home ; and soon after, was seized 



CASES OP THE EPIDEMIC. 171 

with extreme pain in the head and dizziness ; pain 
in the back and limbs; rigors, succeeded by heat 
and thirst; and some pain in the upper part of 
the thorax, nearly under the right clavicle. His 
tongue is dry ; skin dry, and hot to the touch ; pulse 
quick, full, and hard. & Tart. Antim. gr. ii. to be 
repeated twice after intervals of fifteen minutes, 
unless vomiting is sooner produced. As soon as 
the vomiting ceases, give Tinct. Opii Cam. 3i. ; and 
in an hour or two after, commence giving the Pul. 
Ipecac. &c. every four hours ; to each dose of 
which is added Sub-mur. Hyd. gr. i. At bed 
time, if he is restless, give him a drachm of cam- 
phorated tincture of opium. Nourish with soup. 
Apply external sudorifics, and give warm drinks, 
until a diaphoresis appears. 

28th. — The emetic operated favorably, and 
gave some relief. The pain in the thorax is in- 
creased, that in the head somewhat diminished ; 
other symptoms much as before ; bowels regular. 
Apply a blister over the seat of the pain in the 
chest. Continue the Pul. Antimon. &c. every 
four hours. 

March 1st. — Rested pretty well through the 
night. In the morning his skin was moist, and he 
was nearly free from pain. But I was not able 
to visit him so early as I had intended, and he be- 
came destitute of medicine; in consequence of 



172 CASES OF THE EPIDEMIC. 

which, his skin grew dry ; his pain in the head and 
dizziness returned, and became extremely severe. 
His tongue is coated and dry; pulse quick, and 
much more feeble. He is very thirsty. R Pul. 
Ipecac. &c. every four hours ; in the intervals, take 
the fermented decoction of cinchona. Use warm 
aromatic drinks, as freely as the thirst requires, 
and apply external sudorifics. 

2d. — Rested well last night, and feels better 
to-day ; feels more strength and less pain ; pulse 
more nearly natural; skin keeps moist; is less 
thirsty ; tongue coated as much as ever. Con- 
tinue the medicines ; take a little brandy or wine 
occasionally. 

3d. — Is still rather better ; rested well last 
night ; has very little pain ; takes soup with rel- 
ish ; brandy does not suit him ; pulse good ; tongue 
darker; skin continues moist; wishes for cider, 
which he is allowed to take freely. Continue the 
medicines. 

4th. — Worse. He felt very well yesterday af- 
ternoon and evening; but had too much compa- 
ny, with whom he talked very freely, as well as 
in the night with his attendant. He slept tolera- 
bly well, most of the night ; but had several se- 
vere paroxysms of coughing. When he waked 
this morning, he was perfectly hoarse, and con- 
tinues so much so, that he can scarcely speak, ex- 



CASES OF THE EPIDEMIC. 173 

cept in a whisper. His respiration is laborious; 
tongue dry and black ; pulse more feeble ; skin 
moist ; has a diarrhoea, which is probably occa- 
sioned by the cider, of which he has drinked very 
freely. Substitute wine. Take ten drops of 
tincture of opium after every superfluous stool. 
Continue the decoction of cinchona, and the Pul. 
Ipecac. &c. 

5th. — Rested pretty well ; pulse better ; tongue 
more moist, but as black as ever ; is less thirsty ; 
feels more strength; takes soup with relish. His 
voice is entirely gone, so that he can only speak 
in a whisper. Continue the medicines, and give 
brandy or wine frequently. 

6th. — Recovering ; rested well ; pulse preter- 
naturally slow ; tongue still black ; skin moist. 
R Tinct. Cinchon. Compos. 51. every four hours; 
the Pul. Ipecac. &c. every six hours. Continue 
the wine and soup. 

7th. — Expectorates freely ; cough less trouble- 
some ; rests well ; pulse slow, and tolerably full ; 
voice still gone. Continue the medicines. 

Sth. — Still gaining ; sleeps well ; appetite for 
food good ; pulse very slow ; walked into an ad- 
joining room this morning. Continue the medi- 
cines. 



J 74 OASES OF THE EPIDEMIC. 

9th. — Sits up more than an hour at a time, and 
can walk from one room to another, several times 
in succession without fatigue ; tongue still coated 
in the middle ; is still unable to speak but in a 
whisper ; pulse forty in a minute, tolerably strong; 
skin natural. Omit the Pul. Ipecac. &c. unless 
the skin at any time becomes dry. Continue the 
Tinct. Cinchon. Compos, frequently. 

10th. — Still better; somewhat troubled with a 
diarrhoea ; pulse natural. After every stool un- 
til the diarrhoea is checked, take ten drops of 
tincture of opium. Continue the tincture of 
cinchona. 

11th. — Sleeps well; ate a piece of beef steak 
this morning with good relish ; has sat up several 
hours at a time. He has not in any degree re- 
covered his voice. Continue the tincture of cin- 
chona. In a few days after this, his voice began 
to return, and he recovered perfectly well. 



CASE VIII. 

February 27th. — S. C. a boy four years old, 
about four o'clock this afternoon was suddenly 
seized, while at play, with violent pain in the head ; 
nausea and vomiting ; pain in the chest ; chills, 
succeeded by heat, &c. In a short time, delirium 



GASES OF THE EPIDEMIC. 175 

supervened, which, however, lasted but a few 
hours. He is thirsty ; tongue dry ; skin dry ; 
pulse quick and hard. Apply a blister to the 
chest. R Tart. Antimon. gr. ii. one third to be 
given at a time, dissolved in water, and repeated 
every fifteen minutes until vomiting is produced. 
When the vomiting is completed, give Tinct. OpU 
Camph. gt. xxv. In an hour or two after, com- 
mence the Pul. Ipecac. &c. with Sub-mur. Hyd. gr. 
i. every four hours. At bed-time if he is restless, 
give him thirty drops of the camphorated tincture 
of opium. Give warm aromatic drinks for his 
thirst, and apply external sudorifics until a dia- 
phoresis is excited. Nourish with soup. 

28th. — Rested a little in the night ; symptoms 
somewhat, but not greatly relieved ; a moisture 
begins to appear on the skin ; bowels costive. 
R Pul. Antim. &c. with Sub-mur. Hyd. every 
four hours. 01. Ricini quant, suf. 

March 1st. — Rested extremely well, and is so 
much better as to play with his toys ; sits up an 
hour or two at a time. Continue Pul. Ipecac. &c. 
night and morning ; give infusion of quassia fre- 
quently. I did not visit him again. In a few 
days he was welL 



176 CASES OF THE EPIDEMIC. 



CASE IX. 



February 28th. — F. S. a girl of eighteen, com- 
plains in the evening of pain in the head and 
dizziness ; rigors, followed by heat and thirst ; 
tongue and skin dry ; pulse quick, full and hard ; 
she is not, however, very sick, and is not much 
disposed to take medicine, but consents to take a 
compound antimonial powder at bed-time, and 
another in the night. 

28th. — She has had a very restless night. Her 
headach and dizziness are much increased ; 
tongue coated ; thirst, for cold drinks ; skin hot 
and dry ; pulse quick and hard. She has a cough, 
and pain in the left side. Apply a blister over 
the seat of the pain in her side. Give Pul. Anti- 
mon. &e. every four hours ; apply external su- 
doriiics ; allow such drinks as she prefers, but 
with caution ; and give soup for nourishment. 

Towards evening, she began to be in a slight 
delirium, but a diaphoresis soon after commenced 
and relieved her. 

March 1st. — Slept considerably last night, and 
is to-day much better in every respect ; was free 
from pain until she induced some in the he id, by 
too much exercise ; finds herself quite feeble. 
Continue the Pul. Ipecac. &c. and take the com- 



CASES OP THE EPIDEMIC. 177 

pound tincture of cinchona. From this time, she 
recovered, after several partial relapses, occasion- 
ed by imprudent exertion. 



case x. 

March 2d, — S. C. an infant thirteen months old, 
was seized about nine o'clock yesterday morning, 
with violent distress and vomiting. She has had 
no medical advice, until I was called at three 
o'clock this afternoon. She has been growing 
constantly worse since her attack. She is teeth- 
ing, the gums being much swollen over several 
teeth. Her respiration has been very laborious 
from the first. About eleven o'clock this morn- 
ing she was attacked with convulsions, which have 
continued at intervals ever since. Indeed, the 
paroxysms of convulsions do not entirely leave 
her, so but that she is constantly much distressed, 
and insensible to surrounding objects. Her 
tongue is dry, and covered with a thick and very 
black coat ; mouth dry ; the skin was dry, until 
after the convulsions began; pulse quick, but 
not remarkably feeble ; bowels regular. I after- 
wards learned that she had fallen into the fire the 
day preceding her attack, and burned the back 
part of her head, but the burn was not thought 
serious enough, to. induce her friends to shew it 
to me, or to speak of it ; and probably had nothing 
to dp with her sickness. 

23 



178 CASES OF THE EPIDEMIC. 

I immediately scarified the gums, and applied a 
pretty large blister to the sternum. As she lay 
in a stupor, in the intervals of the convulsions, J 
first gave 01. Lavend. gi. i. Tinct. Opii Cam. gt. v. 
with orders to have it frequently repeated as 
there might be opportunity, or occasion; and then 
an emetico-cathartic composed of Pul. Ipecac, 
gr. x. Sub-mur. Hyd. gr. viii. After the emetic 
operation, fifteen drops of camphorated tincture 
of opium were directed to be given ; and in an 
hour, to commence with the Pul. Ipecac. &c. with 
Sub-mur. Hyd. every four hours, if there should 
be opportunity. 

Only a slight emetic effect was produced by 
the medicine. The child, however, became ap- 
parently easier about four o'clock, and lay quietly 
in a comatose state until nearly nine in the eve- 
ning, when the convulsions returned, and before 
ten, she expired. 



CASE XI. 

March 9th. — S. B. a girl five years old, was seiz- 
ed this afternoon with pain in one cheek. The 
pain soon left the cheek, when she complained of 
pain in the stomach, and great general distress. 
Vomiting soon gave a partial relief. She now has 
headach and dizziness ; skin, and tongue dry ; 



CASES OF THE EPIDEMIC. 179 

thirst ; pulse quick, and rather hard. R Pul. 
Ipecac. &c. with Sub-mur. Hyd. one grain in each, 
every four hours; warm aromatic drinks, and 
apply external sudorifics. At bed-time give 
Tinct. Opii Camph. 3ss. 

Wlh. — She has had a restless night, was at times 
in a partial delirium. Has frequent vomitings ; 
stomach rejects most that she takes ; pulse feels 
better ; skin moist ; pain relieved ; thirst con- 
tinues. Continue the Pul. Ipecac. &c. as before. 
In each interval, give half a wine-glass-full of the 
fermented decoction of cinchona. Give Spir. 
Menth. Pip. gt. iv. Tinct. Opii Cam. gt. x. every 
hour. Nourish with soup. 

Evening. — Better, but still vomits considerably, 
though less frequently than in the morning. Try 
her with a cup of good coffee. Give half a 
drachm of the camphorated tincture of opium at 
bed-time. 

11 th. — Considerably better ; has had a good 
night ; pulse more nearly natural ; tongue and 
skin moist; feels very little pain, though she 
complains of some uneasiness in her feet. Con- 
tinue the medicines. 

12th. — In every respect better. She sleeps 
quietly ; has very little pain ; her appetite for 



180 CASES OF THE EPIDEMIC. 

food increases ; tongue and skin continue moist ; 
has no morbid thirst; bowels regular. R Pul. 
Ipecac. &c. night and morning, and at any other 
time if the skin should become dry. Continue 
the decoction of cinchona. This was my last visit. 



CASE XII. 

March 14th. — B. L. brother of A. and S. L. aged 
thirty-three years, is a vigorous healthy mau, ex- 
cept that several months ago he had an attack of 
epilepsy ; of which, however, he has had no symp- 
toms since. He complained a little yesterday of 
pain in his head, and was kept awake by it a part 
of the night, but was so well as to go to his work 
this morning. In a short time he returned, shi- 
vering with rigors, which were soon followed by 
heat ; extreme pain in the head and dizziness ; 
nausea and faintness at the stomach ; thirst. His 
tongue is dry ; skin dry, with a burning sensation ; 
pulse quick and feeble. R Pul. Ipecac. &c. 
every four hours ; in each interval, a glass of the 
fermented decoction of cinchona. When he is 
faint, give Spir. Menth. Pip. gt. viii. Tinct. Opii 
Camph. gt. xv. Take warm aromatic drinks, and 
apply external sudorific s. 

Afternoon. — The pain in the head increased 
so as to produce a delirium for a few hours ; but 



CASE!? OF THE EPIDEMIC. 181 

in the course of the afternoon, a free perspiration 
was induced, and attended by very great relief. 
Soon after this, a cough commenced, with a free 
expectoration of thick mucus. At bed-time give 
twenty-five drops of tincture of opium. 

lbth. — Has had a good night, and feels nearly 
well, except from debility. His tongue is moist, 
and the coat separating from its edges ; skin 
moist ; expectoration free ; pulse of natural fre- 
quency, but feeble. If the skin should again be- 
come dry, take a powder of Ipecac. &c. Con- 
tinue the decoction of cinchona, or substitute 
the compound tincture at pleasure. 

16th. — Much better ; had a good night ; sits up 
most of the day, and has walked out into the 
street. Complains of a pain, which is not very 
severe, in the cheek, under the right eye, pro- 
ceeding probably from inflammation in the 
antrum Highmorianum ; a bloody fluid distils 
from the nostrils. Continue the Tinct. Cinchon. 
Compos, frequently, until the strength is restored. 



CASE XIII. 

March lith. — M. B. an unmarried woman of 
about twenty-five, of good general health, has for 
a week past been troubled with symptoms of indi- 



182 CASES OF THE EPIDEMIC. 

gestion; and with a pain and soreness about the 
sternum, which lias perhaps arisen from the na- 
ture of her employment, which is picking large 
paper in a paper-mill. This morning she was 
seized rather suddenly with chilliness ; great pain 
in the head and dizziness ; nausea, with a feeling 
of general distress, which she was unable to de- 
scribe ; thirst. The ends of her fingers were of 
a livid colour, particularly about the nails. I 
was called in the afternoon. Her tongue was 
then dry, and protruded with some difficulty, skin 
dry ; pulse quick and feeble. It seemed to be 
full upon a slight touch, but yielded very much 
under the finger ; general distress somewhat abat- 
ed. R Tart. Antim. gr. iii. Pul. Ipecac, gr. xv. 
one half to be taken immediately, and the remain- 
der in twenty minutes, unless vomiting is pro- 
duced in the mean time. After the operation of 
the emetic, take a drachm of camphorated tinc- 
ture of opium, and in an hour commence with 
the Pul. Ipecac. &c. every four hours. In 
each interval, take a w T ine-glass-full of the ferment- 
ed decoction of cinchona. Apply a blister to the 
sternum. At bed-time, give Tinct. Opii Camph. 
3i. Take warm aromatic drinks, and use external 
sudorifics, until a diaphoresis is excited. 

She recovered without any farther attendance. 



CASES OF THE EPIDEMIC. 183 



CASE XIV. 

March 1 5th. — Mrs. C. a married woman about 
thirty, generally of very vigorous health, and rather 
gross habit, was yesterday morning taken with 
pain in the head and dizziness ; nausea and vom- 
iting; chills, &c. To-day she has of her own ac- 
cord taken a dose of tartrite of antimony, which 
distressed her considerably in the operation ; and 
towards evening, she sent for me. Her tongue is 
coated and dry, and protruded with some difficul- 
ty ; pulse feeble and rather quick; skin dry, and 
puffy ; she is thirsty ; her limbs are at times 
numb ; she has turns of faintness, and a feeling 
of depression at the stomach. & TPul. Ipecac. 
&c. every four hours; in the intervals, take the 
fermented decoction of cinchona; at bed-time, a 
drachm of camphorated tincture of opium. When- 
ever she is faint, give 01. La vend. gt. iv. Tinct. 
Opii Camph. gt. xv. Take warm aromatic drinks, 
and apply external sudorifics. Nourish with 
soup. 

16th. — Pain in the head diminished ; pulse 
slower and fuller; skin moist by turns, but is not 
kept so ; vomiting and the depression at the sto- 
mach continue ; stomach rejects the decoction of 
cinchona. Continue the Pul. Ipecac. &c. Give 
a spoonful of infusion of quassia every half hour. 



184 UASES OF THE EPLDEiMIC. 

When she is faint, give Spir. Menth. Pip. gt. viii. 
Tinct. Opii Cam. gt. xv. Continue external su- 
dorifics, and soup. Apply fomentations to the 
region of the stomach. Give braudy occasion- 
ally. 

17 th. — She was much relieved yesterday after- 
noon. The vomiting was subdued by giving 
brandy in small quantities ; but that being after- 
wards omitted, the vomiting returned in the night, 
and still continues, accompanied by a violent de- 
sire to drink cold water. This morning the nurse 
indulged her with cold water, which she immedi- 
ately vomited. Her pain in the head was very 
much increased, as well as her thirst, and depres- 
sion at the stomach. I gave her some spirit of 
peppermint in a little hot brandy and water, which 
produced a very grateful sensation in the stomach, 
and relieved the feeling of depression. Her 
tongue is moist ; skin sometimes, but not con- 
stantly so ; countenance very much bloated ; the 
skin over the whole body feels very puffy and 
non-elastic ; pulse slow, and not remarkably fee- 
ble ; bowels costive. She has a strong desire for 
cider; which is to be gratified. R Spir. Menth. 
Pip. gt. viii. Tinct. Opii Camph. gt. xv. every 
hour, if the faintness and vomiting continue. At 
night give Pil. Aloes and Rhei, and repeat it in 
the morning if necessary. Continue other medi- 
cines as before. 



CASES OF THE EPIDEMIC. 185 

18th. — She has had a pretty good night; the 
vomiting has ceased; pain in the head slight. 
The skin was moist in the mining; but she sat 
up until she was very much fatigued, when the 
skin became dry and she was much distressed. 
The perspiration is, however, restored, and she is 
considerably relieved, but complains of distress 
in the region of the stomach. l\<e t ulse, when 
I first saw her to-day, was 84 ; but within an hour 
fell to 78, full and strong; tongue moist, but cov- 
ered with a thick coat of a dark brown colour. 
She takes soup well. The pills have not operat- 
ed upon the bowels. Administer an enema. Ap- 
ply a blister to the left side, as near to the seat 
of the distress, of which she complains, as she will 
permit.* Continue the medicines. 

19JA.— Rested well; feels better; countenance 
better; pulse 84, pretty full; tongue moist, but 
black; skin moist; has very little pain; numb- 
ness diminished ; has a slight pain in the bowels, 
and diarrhoea. Discontinue the cider, or take it 
in smaller quantities. Apply fomentations to 
the bowels, and give ten drops of tincture of opi- 
um, after every superfluous discharge. Give the 
decoction of cinchona, and the brandy more libe- 
rally. Continue the Pul. Ipecac. &c. as before, 
and the camphorated tincture of opium one 
drachm at bed-time. 

* She would not permit a blister to be applied directly to the re* 
gion of the stomach. 

24 



186 CASES OF THE EPIDEMIC. 

20th. — She has had a worse night ; complaint 
of more pain in the head. She is not attended 
with sufficient care. Her skin is suffered to get 
dry, and in consequence, she is much distressed ; 
but is immediately relieved by exciting perspira- 
tion. She had yesterday a severe turn of dis- 
tress and faintness, from a neglect of this kind. 
Her skin is now dry ; pulse 65, feeble. Before 
I left her, the skin became moist, and her pulse 
rose considerably. Her diarrhoea has ceased ; 
numbness diminished ; disposition to faintness in- 
creased; tongue less coated and more natural in 
its appearance. & Tinct. Cinchon. Compos. 3ss. 
every hour ; continue Pul. Ipecac. &c. Take 
brandy, and soup freely. 

Evening, — Has been much distressed, and in- 
clined to faintness, with great difficulty of breath- 
ing, but was soon relieved. Her skin is moist ; 
tongue nearly natural ; pulse quicker and weaker 
than in the morning. & Tinct. Cinch. Com. 3i. 
every four hours; infusion of quassia, a table 
spoonful, every half hour ; other things as before 
directed. 

21st. — Rested well; feels better; countenance 
improved ; tongue nearly natural in its appear- 
ance ; pulse 65, much stronger than yesterday ; 
takes soup with more relish ; costive. Adminis- 
ter an enema. Continue the medicines. 



CASES 6F THE EPIDEMIC. 187 

22d. — Rested well ; has very little pain ; had 
this morning a turn of being very much distressed, 
during which she felt very numb $ complains of 
a sensation which she compares to a ball in her 
stomach ; tongue dry in the middle, but has no 
coat on it; pulse of natural frequency, but rath- 
er feeble. Continue Pul. Ipecac. &c. Add 
tincture of valerian to the tincture of cinchona, 
and take a drachm every two hours. Continue 
brandy and soup freely. 

23d. — Has not had so good a night, but to-day 
is much better. Her countenance is improved ; 
pulse stronger ; numbness and faintness gone ; 
tongue natural, except a very slight white coat ; 
does not relish food. Give the diaphoretic pow- 
der only once in six hours ; other things as be- 
fore. 

2&th. — Feels not quite so well ; slept better last 
night ; was permitted to sleep too long at a time, 
ft Pul. Ipecac. &c. every four hours ; other things 
as before. 

251L — Recovering; pulse and tongue natural; 
bowels in good order. Continue the medicine^. 
She recovered in a short time after this. 



188 CASES OF THE EPIDEMIC. 



CASE XV. 

March 16th. — Mrs. J. a married woman, about 
thirty years old, of vigorous health, was seized this 
morning, while in bed, with extreme pain in the 
head and dizziness ; nausea, and soon after, vom- 
iting ; chilliness, succeeded by heat. She is 
thirsty ; her tongue is dry, and protruded with 
difficulty ; skin dry ; limbs at times numb. 
She complains of general distress ; and of a feel- 
ing of depression at the stomach, which at times 
is particularly severe. Her bowels are regular, 
ft Pul. Ipecac. &c. every four hours; in the in- 
tervals a wine-glass-full of the fermented decoc- 
tion of cinchona; at bed-time Tinct. Opii Campb. 
3i. Apply spiritous fomentations to the region 
of the stomach, and give Spir. Mentb. pip. gt. 
viii. Tinct. Opii Cam. gt. xv. every hour, or from 
that to every three hours, according to the ur- 
gency of the vomiting. Take warm aromatic 
drinks; apply external sudorifics, until perspira- 
tion is excited ; give soup for nourishment ; and 
a little brandy according to the degree of depres- 
sion, felt at the stomach. 

11th. — She has had a tolerably good night. Hei 
skin is moist ; pain in the head relieved ; vomit- 
ing continues ; stomach rejects the decoction of 
cinchona ; the numbness of the limbs is increased ; 



CASES OF THE EPIDEMIC. 189 

bowels in good order : has very little pain in any 
part; has a copious and free expectoration of 
thick mucus streaked with blood, without any 
cough ; has no pain in the chest ; respiration easy. 
Give a spoonful of infusion of quassia every half 
hour. Omit the decoction of cinchona. Continue 
other medicines. 

18th.- — Better; did not sleep so well last night 
as she did the night before, but was not prevent- 
ed by pain ; the vomiting stopped yesterday, and 
did not trouble her through the night, but has re- 
turned this morning. Her tongue is moist, stiil 
protruded with some difficulty ; pain in the head 
gone ; dizziness continues, in a slight degree, par- 
ticularly upon motion of the head; skin constant- 
ly moist ; expectoration diminished ; no cough ; 
has very little pain ; faint ness gone ; pulse ninety ; 
takes soup well, and cider very freely ; bowels 
costive. R Pul. Ipecac. &c. every six hours. 
Continue the infusion of quassia. If the stomach 
will receive it, recommence with the fermented 
decoction ; continue the Spir. Menth. Pip. &c. as 
often as the vomiting shall require it. At bed 
time, repeat the Tinct. Opii Camph. 5L If noth- 
ing passes the bowels before night, give the Pil. 
Aloes and Rhei, and repeat it in the morning if 
necessary. 

19th. — She has rested better last night, than 
any night before since she has been sick. Her 



190 CASES OF THE EPIDEMIC. 

skin is constantly moist; her tongue is moist ; 
thirst less. She takes the decoction, and brandy, 
and soup well ; is free from pain ; numbness gone ; 
expectoration continues moderately ; pulse 84, 
full ; the pills have operated upon the bowels. 

20th. — Has slept very well in the night, and 
feels better this morning ; continues free from 
pain and numbness ; tongue moist, and the coat 
separating from it ; skin constantly moist ; sweat 
considerably in the night. Omit the diaphoretic 
powder in the night ; in other respects continue 
the medicines, and give tonics more liberally. 

21 si. — Continues to recover; has been able 
to sit up two hours this morning ; pulse and skin 
nearly natural ; coat separating from the tongue ; 
bowels costive. Give the Pul. Ipecac. &c. night 
and morning; ; other things as before. At night 
give Pil. Aloes and Rhei, and repeat in the morn- 
ing if necessary. She was soon well. 



CASE XV J. 

March 16th. — Mrs. L. a young married wo- 
man, of good general health, was seized on the 
12th inst. at Augusta, (whither she had gone to 
attend the funeral of her father) with the usual 
symptoms, pain in the head, dizziness, &c. She 



tiASES OF THE EPIDEMIC. 191 

was brought home the 13th, but has had no phy- 
sician till to-day. She now has no constant se- 
vere pain. Her pulse is feeble and rather quick ; 
tongue coated and dry ; skin dry. Her limbs are 
at times numb. They are slightly swelled, and 
have a puny feeling. She feels an almost constant 
disposition to vomiting, and is much inclined to 
faintness ; has a troublesome dry cough, with- 
out any expectoration ; has a strong desire for 
cider. Allow the cider freelv ; take the PuL 
Ipecac. &c. every four hours ; the fermented 
decoction of cinchona, a wine-glass-full, in each 
interval ; Spir. Menth. Pip. gt. viii. Tinct. Opii 
Camph. gt. xv. at intervals of from one to three 
hours ; at bed-time Tinct. Opii Camph. 3i. Take 
warm aromatic drinks, and a little brandy occa- 
sionally, and apply external sudorifics until per- 
spiration is excited. Nourish with good soup. 
Apply spiritous fomentations to the region of 
the stomach. 

17th. — Yomiting continues ; tongue dry ; thirst 
not very urgent ; coughs much less, and expec 
torates freely ; pulse natural in respect to fre- 
quency, but feeble ; has sweat considerably dur- 
ing the night, but the skin is now dry ; limbs feel 
puffy, and are at times numb. She dislikes bran 
dy, but takes cider with great relish. The de- 
coction of cinchona was not well fermented, and 
her stomach rejects it. The spirit of pepper- 



192 CASES OF THE EFIDEMI6. 

mint, &c. gives a very grateful sensation to the 
stomach. Omit the decoction of cinchona. Take 
infusion of quassia, a spoonful every hour. Con- 
tinue the other medicines. 

18th. — Better; skin moist; vomiting ceased ; 
numbness gone ; tongue moist, but is not easily 
thrust out of the mouth ; pulse ninety, pretty- 
strong ; takes soup welJ ; bowels costive. Take 
the fermented decoction of cinchona every four 
hours. Continue the infusion of quassia, and 
other medicines as before. R Pul. Rhei gr. xv. 
to be followed by an enema in two hours, unless 
the bowels are moved in the mean time. 

19th. — She rested well through the night, until 
about four o'clock this morning ; when she sud- 
denly, and without any apparent cause, became 
very faint, and soon after was subject to severe 
general distress. She complained of a sensation 
of great internal heat, and had an urgent desire 
for cold water. This desire was gratified, by 
giving her small quantities at a time. She soon 
vomited, and was relieved. She now complains 
of no pain, nor numbness. Her pulse is of natu- 
ral frequency, and pretty good strength ; her 
tongue is protruded with difficulty. It is moist, 
and covered with a dark coat. The bowels are 
still costive, the rhubarb and enema having pro- 
duced onlv a small discharge, which was hard. 



OASES OF THE EPIDEMIC. 193 

She was much fatigued, by having the enema ad- 
ministered. Her attendants are awkward, and 
unaccustomed to sickness. & Pul. Rhei gr. xx, 
and if it does not operate in two hours, repeat the 
saiiie quantity. Continue the Pul. Ipecac. &c. 
Take Tinct. Cinch. Com. 31. every two hours, 
brandy frequently, and soup freely. 

20lh. — Slept very well last night ; feels better ; 
less prone to faintness ; has very little numbness ; 
pulse eighty, pretty strong ; tongue of a dark 
colour, moved with more ease ; expectoration 
continues free. Continue the medicines, except 
the rhubarb. 

21st.— Better ; had a distressed turn last even- 
ing, but vomited and was relieved ; passed a very 
good night. The pulse is nearly natural. Con- 
tinue the medicines. 

22d. — Better ; had a very good night ; counte- 
nance improved ; has no pain ; very little numb- 
ness ; pulse nearly natural ; tongue black ; dis- 
likes soup. Continue the medicines. Substitute 
the juice of broiled meat for the soup. 

2 3 d.- — She did not sleep so well as usual last 

night, though free from pain ; feels pretty well ; 

has no numbness nor faintness ; sat up half an 

hour this morning without fatigue ; pulse nearly 

25 



194 OASES OF THE EPIDEMIC. 

natural ; takes food with relish ; tongue moist, 
but black, except at the edges. Give the Pul. 
Ipecac. &c. only night and morning ; other medi- 
cines as before. 

2itL — Her skin became dry this morning, and 
she had a turn of chilliness, though the skin felt 
hot to others. She was relieved by exciting per- 
spiration. R Pul. Ipecac. &c. every six hours 
Continue other medicines. 

&5th. — Better ; slept well last night ; has no 
pain ; can sit up three quarters of an hour, without 
fatigue ; appetite for food improves. Continue 
the medicines. Her convalescence was lingering ; 
but she regained tolerably good health in a few 
weeks. 



case xvii. 

March \lth. — Mrs. W. a married woman, aged 
about thirty, was taken in the night of the 14th 
instant, with chills, pain in the head, &c. ; but has 
had no medical advice till this evening. She 
now complains of faintness and extreme dizziness, 
especially if she raises her head from the pillow ; 
pain in the back and limbs ; occasional numbness 
in the limbs, which have a very puffy feeling : 
nausea and distress at the stomach, with loss of 



CASES OP THE EPIDEMIC. 195 

appetite, but no vomiting; tongue coated and 
dry ; tongue and jaws feel stiff; skin dry, though 
she has sweat at times in the night ; pulse feeble, 
but of natural quickness : bowels costive, and 
sometimes in pain. R Pul. Ipecac. &c. every four 
hours ; in each interval, a wine-glass-full of the 
fermented decoction of cinchona. Give also, Pil. 
Aloes and Rhei, to be repeated in the morning if 
needed ; and at bed-time, Tinct. Opii Cam ph. 3i. 
Take warm aromatic drinks. Apply external 
sudorifics, Nourish with soup. 

18th. — Pain less ; nausea continues at intervals ; 
skin not constantly moist ; tongue moist, and 
much coated ; no thirst; pulse sixty, small and 
feeble. The pills have not operated upon the 
bowels. R Pul. Rhei gr. xx. to be followed by an 
enema in two hours, if the bowels are not moved 
in the mean time. Continue other medicines as 
before, and take brandy frequently, 

19th. — Better ; rested pretty well last night ; 
numbness gone ; countenance better ; tongue 
moist ; no thirst ; bowels not yet moved ; has 
only just now had the enema administered. Con- 
tinue the medicines, 

20th. — Slept perfectly well ; feels no pain nor 
numbness ; appetite for food, good ; pulse rather 
feeble ; tongue moist, coat separating at the 



196 CASES OF THE EPIDEMIC. 

edges. R Tinct. Cinchon. Comp. frequently ; Pul. 
Ipecac. &c. night and morning ; brandy freely. 

Afternoon. — After I left her this morning she 
had company, and sat up till she was very much 
fatigued. Her skin became dry, and about half 
past twelve, she became extremely faint, and 
much distressed. She was relieved in about an 
hour and a half, by exciting a perspiration. I 
then ordered the Pul. Ipecac. &c. to be given 
every four hours ; other things as before ; and 
repeated the injunctions of rest and quietness. 

21st — She is feeble, and much disposed to faint- 
ness ; complains of a feeling of depression at the 
stomach ; has very little pain ; pulse slow, and 
feeble ; bowels costive, except a« they were mov- 
ed by an enema yesterday. Continue the medi- 
cines. 

22c7. — Better ; had a good night ; appetite for 
food good ; has no pain , very little numbness ; 
feels pretty well. Continue the medicines. 

23c?. — Much better ; feels well, except that she 
is feeMe ; eats well ; sleeps well ; has no pain, 
nor faintness ; nor numbness ; tongue natural ; 
pulse stronger and somewhat quickened. Con- 
tinue the tonics. From this time she recovered 
very rapidly. 



CASES OF THE EPIDEMIC. 197 



CASE XVIII. 

March lttth. — G. G. a vigorous healthy boy, four 
years old ; has for a week past been affected, 
though not very severely, with sympoms of catarrh. 
On the 15th inst. he was seized with vomiting; 
since which time, he has frequently had turns of 
sickness at the stomach, but has not vomited 
since yesterday. His complaints now are loss of 
appetite ; dizziness and faintness, particularly 
when raised out of a horizonal posture. He has 
not much pain ; very little thirst in the day time, 
though he had more in the night ; tongue coated, 
white, and moist ; lips parched ; skin dry, but 
not particularly hot, or cold ; pulse one hundred 
and thirty-four, small and feeble. He yesterday 
took a dose of sulphate of soda, which operated 
twice without giving any relief ; and was after- 
wards sweated by placing billets of wood, taken 
out of boiling water, around him in bed, with 
some apparent benefit. He rested pretty well 
last night. To-day he coughs and expectorates 
sparingly, a frothy mucus. The fauces are sore. 
Give the Pul. Ipecac. &c. eyevy four hours ; in 
the intervals, the fermented decoction of cin- 
chona ; at bed-time thirty drops of camphorated 
tincture of opium ; a little brandy occasionally. 
Give warm aromatic drinks, and apply external 
sudorifics, unless a diaphoresis is speedily obtain 



198 CASES OF THE EPIDEMIC. 

ed without them. Let him take soup for 
nourishment. 

19^. — Had rather a restless night, though not 
from much pain, but to day is better. His faint- 
ness, and nausea are gone ; dizziness diminished ; 
tongue moist ; skin constantly moist ; pulse one 
hundred ; takes some soup ; bowels costive since 
the 17th. R Pul. Rhei gr. x. Continue other 
medicines. 

20th. — Better ; slept well ; appetite for food 
good ; skin continues moist ; tongue moist, but 
still coated. The rhubarb has not moved his bow- 
els. RPul. Rhei gr. xv. and unless it operate in 
two or three hours, administer an enema. Give 
the Pul. Ipecac. &c. every six hours. Continue 
the decoction of cinchona, and brandy. He re- 
covered without any further attendance. 



CASE XIX. 

March 2lst. — H. M. a young unmarried wo- 
man, has this afternoon attended the funeral of an 
acquaintance. About seven o'clock she sat 
down to supper with the family, though she felt 
not much appetite. While at supper, she was 
suddenly seized with extreme distress in the 
stomach and head, which was in a few minutes 
followed by delirium. When I arrived, which 



GASES OF THE EPIDEMIC. 199 

Was in a short time, she was cold, helpless, and 
took no notice of surrounding objects. Her res- 
piration was laborious. She had frequent con- 
vulsive contractions of the muscles. Her pulse 
was very feeble, and rather slow. 

While other things w T ere preparing, I immedi- 
ately gave her a drachm of camphorated tincture 
of opium in some warm tea. As soon as it could 
be done, bricks were heated, and had water pour- 
ed over them, rolled in cloths, and put around 
her in bed. In a few minutes, some brandy was 
procured, when I gave her a table spoonful di- 
luted with hot tea. I ordered the frequent re- 
petition of these remedies, with the addition of 
the Pul. Ipecac. &c. every three hours, until a 
free perspiration should be excited ; after which 
the powder was to be given only once in four 
hours, the brandy frequently, and other things 
as occasion should require. The camphorated 
tincture of opium was to be repeated in two 
hours if the distress continued. In a short time, 
she was a little relieved, and her pulse rose ; 
when I was obliged to leave her. 

22d. — She has had a restless night, except from 
about twelve to three o'clock, when her skin 
was moist, and she slept considerably. Her skin 
is now dry ; tongue covered with a brown coat, 
She complains of some thirst ; great pain in the 



200 CASES OF THE EPIDEMIC. 

head ; pain under the sternum, to which she has 
long been subject. Apply fomentations to the 
chest; continue the Pul. Ipecac. &e. every four 
hours. In each interval, give a wme-glass-full of 
the fermented decoction of cinchona. Continue 
warm aromatic drinks, and brandy occasionally, 
and give soup. 

Evening. — She has vomited several times to- 
day, and is faint ; has more numbness than in the 
morning ; tongue darker and more coated ; pulse 
stronger : skin dry. She thinks the decoction of 
cinchona distresses her. R Lavend. 01. Volat. 
gt. iv. Tinct. Opii gt. viii. every two hours. 
Omit the decoction, and take infusion of quassia 
a spoonful every half hour. 

23c?. — Has passed a good night and is better. 
She has very little pain. The faintness and numb- 
ness are much diminished ; her tongue is black ; 
skin rather dry, but less so than it was yester- 
day ; bowels costive. She takes medicine and 
soup well. Continue the Pul. Ipecac. &c. and in 
the intervals, give the fermented decoction of cin- 
chona. Give brandy more freely ; soup as be- 
fore; camphorated tincture of opium, a drachm 
at bed-time. Give also at night Pil. Aloes and 
Rhei, and repeat in the morning, if the bowels 
are not moved. 



CASES OF THE EPIDEMIC. 201 

Mlh. — Has rested well ; skin more moist ; 
pulse slow, and feeble ; tongue quite black ; feels 
some distress and faintness at the stomach ; the 
pills have not operated ; dislikes brandy, but 
takes the soup pretty well. Substitute wine for 
the brandy ; administer an enema. Continue the 
medicines with the addition of Menth. Pip. 01. 
Vol. gt. ii. Tinct. Opii gt. vi. every hour, if the 
faintness continues, or whenever it is trouble- 
some. 

2bth, — Better ; rested well in the night ; has 
not much pain ; tongue looks better ; pulse 
stronger ; bowels not yet moved ; R 01. Ricini 
iss. and repeat if necessary, until a discharge is 
procured. Continue other medicines. She re- 
covered in a few days. 

My minutes of the two following cases are 
less particular than those of the preceding. They 
occurred at a time when the sickness was too 
prevalent lo allow me sufficient leisure to record 
more than the most prominent symptoms, or 
rather such as had less frequently occurred, of 
the cases, which came under my observation. 

CASE XX. 

March 28tL— Mr. B. is a gentleman eighty 
years old, and is remarkable for his good general 

26 



202 CASES OF THE EPIDEMIC. 

health, and for his vigorous and active habits. He 
was seized yesterday with great and universal 
distress, and a sort of stupor, amounting almost 
to insensibility. He made use of the warm pe- 
diluvium, and was put into bed, and measures 
taken, by external applications, to excite perspi- 
ration. This morning, when I visited him, his 
pulse was quick and feeble, and he had most of 
the other symptoms, so frequently described as 
constituting a severe case of the fever. I pre- 
scribed the Pul. Ipecac, kc. and the fermented 
decoction of cinchona, to be given alternately, 
each at intervals of four hours, and a drachm of 
camphorated tincture of opium at bed-time. The 
diet and drink as in the other cases. 

On the following day he was partially re- 
lieved ; but his symptoms continued nearly the 
same, and the same medicines were continued, 
with the addition of powdered rhubarb for cos- 
tiveness. 

The 30th, infusion of quassia was added to his 
other medicines in the morning ; and in the eve- 
ning, the tincture of rhubarb and gentian was 
prescribed for costiveness ; and volatile oil of 
lavender, oil of peppermint and tincture of opi- 
um, for the vomiting, which had commenced in 
the afternoon. 

As the vomiting subsided, he was inclined to 
coma, which was met by a vigorous exhibition 



CASES OF THE EPIDEMIC. 20!* 

of the tonics and stimulants already mentioned. 
He was at the same time carefully supported by 
soup, and such other nourishment as he could 
take. Care was of course taken to keep him in 
a moderate perspiration, avoiding as much as 
possible a profuse sweat. As he disliked bran- 
dy, and had in his house some Jamaica spirit and 
gin, which were remarkable for their excellence 
and age, he was allowed to make use of these as 
substitutes, although he took them with reluct- 
ance, and in small quantities. 

April 3d. — He began to be affected with a 
hiccough, which continued' more than a week, 
most of the time with extreme violence. About 
the same time, his throat became sore ; and in 
two or three days, the soreness increased to such 
a degree as to prevent him from taking by mouth 
any of the cordials, or any kind of spirit. He 
however continued to take some wine, and the 
fermented decoction, and soup, freely, until 
the 8th ; when a nausea being added to his other 
complaints, he utterly refused to take any thing 
into his stomach, except the fermented decoction, 
and occasionally a little mild drink. 

In the mean time I had given as much tincture 
of opium in mucilaginous drinks, as I thought his 
system would bear, in the hope of allaying the 
irritation in his stomach, which occasioned the 



204 CASES OF THE EPIDEMIC, 

hiccough. Injections composed of soup, slight 
ly seasoned, brandy, and from ten to fifteen drops 
of tincture of opium, had been administered sev- 
eral times a day, for the three days preceding. 
His pulse had been increasing in strength since 
his attack, and diminishing in frequency, until 
that day, when it was worse. On that evening 
(April 8th) the injections were directed to be 
repeated every two hours, with 30 drops of tinc- 
ture of opium in each. He continued the decoc- 
tion freely, and every three hours took in it, 
thirty drops of tincture of opium ; the Pul. Ipe- 
cac. &c. was continued every four hours, when it 
could be done, mixed in any liquid in which he 
would best take it. Fomentations were applied 
to the region of the stomach. 

By these means his hiccough was subdued ; his 
throat in a day or two recovered, so that he was 
able to take food and medicine by mouth, and he 
became decidedly convalescent. The first arti- 
cle of food, that he w T ould consent to take, was 
broiled ham. He ate it with relish, and without 
any injury. From this time he recovered so 
rapidly, that on the fifteenth, I discontinued my 
attendance. He has since regained his former 
activity and vigour, to a degree much beyond 
that of most persons, of his advanced age. 



GASES OF THE EPIDEMIC. 205 



CASE XXL 

April I5tk— Mrs. G. is a lady of about forty, 
a daughter of Mr. B. She has an infant, not quite 
two months old. For more than a week past, she 
has resided constantly at her father's, to aid in tak- 
ing care of him and his family, others of whom 
are also sick ; though on account of her infant, 
she has been less in the sick room, than others of 
her friends. She was attacked this morning, 
with pain in the bowels and diarrhoea, which 
were soon followed by the other symptoms of 
the fever. She was directed to take the PuL 
Ipecac. &c. every four hours, and ten drops 
of Tinct. Opii after every superfluous stool, un- 
til the diarrhoea should be checked. She also 
took the fermented decoction of cinchona in the 
intervals of the powder, and other things as usual 
in other cases. 

On the following day she was considerably re- 
lieved, but was troubled with frequent vomitings, 
for which she took the volatile oils of lavender 
and peppermint, with tincture of opium ; at the 
same time that she continued the other medicines, 
with as much regularity as the vomiting would 
permit. 

The 17th she was in every respect much better, 
and continued the medicines. Her skin was 



y 



206 CASES OF THE EPIDEiMlC. 

moist, she was nearly free from pain, and seemed 
in a way to recover with rapidity. But in the 
night, the weather became suddenly colder than 
it had previously been ; and her attendants were 
not aware of the change, so as to guard against its 
effects, -until she had felt them severely. Her 
skin became dry; she was much distressed ; her 
limbs numb ; her tongue dry, and black. 1 found 
her nearly in this situation, on the morning of the 
38th. A perspiration was speedily excited, which 
relieved her distress. Her vomiting returned in 
the course of the day, and as that subsided, she 
sunk into a coma. Her face was turgid and of 
a deep crimson colour ; the whole body covered 
with a profuse sweat ; the skin puffy and non- 
elastic to the feeling of others, and inclining to 
numbness and insensibility to herself. She would 
answer when spoken to, but her answers were 
often incoherent and wild. 

A large blister was applied to the back of the 
neck, cold water and ice to the head. She was 
diligently rubbed over the whole surface of the 
body with flannel, and the limbs with a solution 
of cantharides. At the same time, a vigorous 
course of stimulants was administered internally, 
both by mouth and by injections. An efferves- 
cing mixture, made with carbonate of potass foi- 
led by an acid, was given frequently, as well as 
the stimulants so frequently mentioned in the 



CASES OF THE EPIDEMIC. 207 

preceding pages. By these means the coma was 
completely arrested in the course of the day, the 
19th; and by the 20th she was again decidedly 
convalescent. 

From this time she recovered rapidly ; and I 
left off my attendance on the 28th. In the course 
of her convalescence, she was affected with a 
slight eruption upon the skin, which continued 
a day or two, and then spontaneously disappeared. 
This eruption made its appearance at this period 
of the Epidemic in almost every case, while the 
patient was recovering, but did not seem to pro- 
duce any consequences of importance. 



CASE XXII. 

May 16/A. — W. J. is about thirty-five years 
old, of a very robust habit. His business, which 
is the manufacture of boards, has for many years 
exposed him to great fatigue, to labour in the 
water, and to the vicisitudes of the weather, by 
which his constitution has become exceedingly 
hardy. For several days past his exposure has 
been much greater than usual, in consequence 
of a flood, which threatened the destruction of 
his property. He has laboured almost inces- 
santly night and day, frequently in the water, 
and almost constantly with his clothes wet by the 
rain, which has been very abundant ; at the same 
time that he has been subject to extreme anxiety 



208 CASES OF THE EPIDEMIC. 

of mind, in apprehension of the ruin which seemed 
to await him. During this period, he has two or 
three times been considerably ill, with pain in 
the head and back, and other symptoms of fever, 
for which he has taken measures to excite per- 
spiration ; and being relieved by it, has then gone 
out and exposed himself as before. 

Yesterday his exertions and anxiety were in- 
creased to the utmost extent. He was seen with 
his coat off, standing in the water, up to his waist, 
with the sweat streaming from his face, while the 
rain was still falling, using every effort to save 
his property, which the flood was carrying away. 
Soon after this, he returned home much exhaust- 
ed, and in great pain and general distress. But 
something else occuring to him to be done, he 
again went out in the rain, upon the river to 
secure his timber. While he was out, he was 
seized with vomiting ; which, however, did not 
deter him from proceeding to accomplish his 
object. Immediately after his return, he put his 
feet into warm water, and went to bed. He was 
in great pain ; chilly ; skin hot and dry ; thirsty, 
&c. He complained also of a peculiar pain in 
his throat, which was very severe. He slept 
very little, if any, through the night. I was not 
called until this morning. 

Measures had been taken by the family, to 
procure a diaphoresis, by giving him warm drinks, 



CASES OF THE EPIDEMIC. 209 

and applying external sudorifics ; and had been 
successful so as to oive him considerable relief. 
When I saw him, he felt that he was very sick, but 
without any very specific complaints, except an 
occasional vomiting. The pain in his throat had 
left him, with the other pains, when the diapho- 
resis appeared. His pulse was quick, and feeble ; 
tongue dry, and coaled. 

His mind was still very far from being in a 
state of quietness or composure. In addition to 
his apprehension for the loss of his property by 
the flood, which still continued, he now recol- 
lected that his accounts were in a careless state ; 
so that if he should die (of which he felt a strong 
probability) his friends would be liable to suffer 
much inconvenience and injustice. His uneasi- 
ness upon this point was so great, that he had pro- 
cured a friend, to make memoranda, as he revolv- 
ed his affairs in his mind, of a great variety of 
articles, which should have been charged and 
credited in his accounts. I remonstrated strongly 
against this exertion of his mental faculties, and 
endeavoured to calm his agitation ; but without 
much success in either. I directed him to take 
the Ful. Ipecac. &c. and the fermented decoction 
of cinchona, alternately, each at intervals of four 
hours ; and the volatile oil of peppermint with 
tincture of opium, in small doses according to 
circumstances. 

27 



210 CASES OF THE EPIDEMIC. 

Early in the afternoon, I visited him again. 
The friend who was with him in the morning, 
being considerably interested in the settlement 
of his estate, had continued, notwithstanding my 
remonstrances, for more than two hours, to excite 
him to recollect all the circumstances of his 
business, that he might take minutes of them. 
As soon as he was gone, Mr. J. called his work- 
men, and gave them particular directions how to 
proceed in his business. In this he was occupied 
nearly another hour, and almost immediately 
after, sunk into a comatose state ; in which situa- 
tion I found him. When he was spoken to, he 
would open his eyes, give a vacant stare, and if 
powerfully excited, would answer correctly, and 
immediately sink back into stupor, and apparent 
insensibility. He swallowed readily whatever 
was put into his mouth. His pulse was quicker 
than natural, apparently full, upon a slight touch, 
but yielded very much, and almost disappeared, 
under the pressure of the finder. The tongue 
was covered with a thick dark-coloured coat. 
The skin had an appearance of fullness, over the 
whole body, but more remarkably in the face, 
which was very red ; it was rather non-elastic to 
the feeling, and poured out a profuse perspiration. 
A consultation was had at this time, and a very 
vigorous use of the stimulant remedies which have 
been often mentioned, particularly of the more 
diffusiole stimuli, was prescribed. A large blister 



CASES OF THE EPIDEMIC. 211 

was applied to the back of the neck. The fore- 
head and temples were directed to be frequently 
wet with cold water, or vinegar and water, and 
stimulating applications to be made to the feet ; 
and the surface of the body, to be rubbed with a 
solution of cantharides. 

Evening. — The coma continues, and the other 
symptoms much as in the afternoon, except 
that the patient is roused with more difficulty. 
Continue the medicines very diligently; apply 
blisters to the legs ; and -throw up stimulating 
injections. 

May 17th.— The coma continued until about 
twelve o'clock last night, when he . awoke and 
was perfectly rational, and his mind clear, for 
nearly two hours. Unfortunately his attendant, 
with a very benevolent but mistaken zeal, thought 
it more important to improve this opportunity 
in taking care of his soul's health, than in admi- 
nistering the remedies which had been prescribed : 
and instead of giving the medicines with care 
and attention, and of promoting his rest and 
quietness, as he ought to have done, and had been 
strictly enjoined to do ; he spent the whole time 
in talking, and exciting him to talk, of his hopes 
and prospects beyond the grave. According to 
the report of the attendant, Mr. J. carried on an 
almost uninterrupted conversation for about two 



212 CASES OF THE EPIDEMIC. 

hours, and then sunk back into a deep coma, from 
which he never awoke. 

When I saw him this morning, his face was of 
a deep crimson, almost purple colour ; his respira- 
tion slow, deep, laboured and stertorous ; his 
tongue black; pulse slow, and apparently full, but 
exceedingly compressible ; the whole surface of 
the body covered with a profuse perspiration. 
It was impossible to rouse him from his comatose 
state, so as to make him speak or take notice of 
any object The liquids which were put into 
bis mouth, he ejected with great force on to the 
bed, or into the faces of his friends; as if suffi- 
ciently sensible to be conscious of their presence, 
but not enough so to swallow them. The re- 
medies were continued as long as there was any 
opportunity of doing it ; but he died at about 
ten o'clock. 

I wished very much to make an examination 
of the body, but in vain. 



CASE XXIII. 

May 19th, — Mrs. S. is a married woman of 
about thirty-five, of rather feeble general health. 
She felt a little ill, last evening, but not so much 
so as to induce her to make it known to her 
friends. She passed a good night, and attended 



GASES OF THE EPIDEMIC. 213 

as usual to the occupations of the family this 
morning, until about eleven o'clock, when she 
suddenly became very ill. She complained of 
no specific pain, but of extreme distress, and a 
feeling of faintness or sinking, which were more 
particularly severe in the stomach and head. In 
a short time, her face, neck and breast were cov- 
ered with purple spots ; which, however, soon 
disappeared, and she seemed to be rapidly sink- 
ing into a state of complete insensibility. Her 
friends gave her a spoonful of camphorated spi- 
rit, and immediately after, some spirit of pep- 
permint and brandy, by which she was a little 
revived. 

I arrived in about an hour and a half, from 
the time of the violent attack. Her face was 
somewhat swelled, of a deep crimson colour, 
with a livid hue about the eyes ; and there was a 
preternatural fullness extending over the whole 
surface of the body. She was entirely helpless, 
and complained of coldness, though not cold to 
the feelings of others. The skin was dry, as well 
as her tongue and mouth ; pulse quick, and low. 
She was so much inclined to drowsiness, that it 
was with difficulty, that she could be kept 
awake. Her mind seemed perfectly calm, and 
she was ready to second with her whole volunta- 
ry powers, all the efforts we were disposed to 
make for her recovery. 



214 CASES OP THE EPIDEMIC. 

I began by giving her Tinct. Opii gt. x. Spir. 
Merit!]. Pip. gt, x. 01. Lavend. gt. viii. every 
half hour; and in each interval, ten grains of 
camphor and one of opium, added to two grains of 
the Put. Ipecac. &c. already described. Brandy 
was given as hot as she could take it, so freely, 
that in six hours, she had taken at least a pint ; 
and occasionally a little soup, which was highly 
seasoned. A blister was applied to the back of 
the neck, and highly stimulating poultices to the 
feet. Billets of wood steeped in boiling water 
were wrapped in cloths and placed around her, 
under the bed clothes ; and the whole surface of 
the body rubbed with hot spirit, as fast as it 
could be done without exposure to the air. 

In a short time her pulse rose a little, the skin 
became moist, the drowsiness diminished, and in 
less than two hours, vomiting commenced. As 
this symptom was increased by the opium and 
camphor, they .were necessarily omitted. The 
other remedies were continued, in small quanti- 
ties frequently repeated, as she could take them; 
and as soon as the drowsiness w r as nearly gone 
(which w T as in the course of a few hours) the fer- 
mented decoction of cinchona was added. Fo- 
mentations, made with bitter herbs folded in flan- 
nel and dipped in spirit, were applied hot to the 
region of the stomach. — The vomiting increased, 
and became extremely urgent. There was no 



CASES OF THE EPIDEMIC. 215 

continued nausea, but simply an immediate rejec- 
tion of almost every thing received into the sto- 
mach. It was necessary to suspend almost en- 
tirely, the exhibition of every thing, except such 
articles as would be likely to arrest this disposi- 
tion to vomiting. The remedies given for this 
purpose, although they seemed at first to ac- 
complish the object, lost their efficacy as soon 
as the stomach became a little accustomed to 
their action. The volatile oils of lavender, pep- 
permint and turpentine were given, sometimes 
separately, and sometimes combined, in a tea- 
spoonful of any hot licjuid, always with good 
effect for a short time ; but neither of them were 
permanently useful. Hot brandy, given by tea- 
spoonfuls, at first pure, then seasoned with pi- 
mento, and afterwards with pepper, was more 
constantly serviceable than any thing else that 
was tried. It was three o'clock in the morning, 
before the vomiting was in any considerable de- 
gree subdued. She was all this time extremely 
restless ; her pulse had grown again very feeble, 
and she seemed nearly exhausted. From three 
o'clock until sunrise, she rested considerably, and 
was then somewhat revived. 

Throughout the day the 2Qlh, Mrs. S. was tole- 
rably comfortable. She could take her medi- 
cines and soup, in small quantities tolerably well. 
The fermented decoction she relished verv 



216 CASES OF THE EPIDEMIC. 

much. She vomited but two or three times in 
the course of the day. Through the night she 
continued nearly in the same state. 

Before sunrise the 21st, she began to complain 
of oppression at the stomach, and refused to take 
any thing but the decoction of cinchona. I now 
ordered small injections composed of brandy and 
soup, with a sufficient quantity of tincture of opium 
to secure their retention, to be thrown up every 
thr^e or four hours. As she was costive, I soon 
after directed an emollient enema to be administer- 
ed ; to be followed by another, composed of yeast 
and brandy, as soon as the first should operate. 
It was not until a considerable time had expired, 
and after the injection had been repeated, that 
the bowels were moved. In the mean time, two 
or three stimulant enemas were administered, 
but without tincture of opium in them. She 
was very much exhausted by the discharge from 
the bowels, when it took place, which was very 
copious ; and lay some time in a state of almost 
complete exhaustion. While in this state she 
entirely refused to take any thing but cold water. 
This was allowed her, at first very sparingly, 
but afterwards, as it seemed to refresh her, she 
was permitted to drink it in large quantities. 
After being in this state several hours, she began 
to take a little wine, and in a short time, the fer- 



CASES OF THE EPIDEMIC. 217 

merited decoction. From this moment her de- 
sire for water ceased. 

May 22d — She has had a second discharge 
from the bowels this morning. She has been 
quite comfortable since about two o'clock this 
morning, although extremely feeble and exhaust- 
ed. She takes wine, the fermented decoction, 
and brandy in panada, occasionally, but in very 
small quantities. Injections of soup, with a 
wine-glass-full of brandy, and tincture of opium, 
w 7 ere administered every two or three hours. 
From thirty to sixty drops of tincture of opium 
were necessary to secure the retention of the 
injections. Towards evening, as she became 
able to take more by mouth, the injections 
were administered less frequently. 

23d. — She has had a pretty comfortable night ; 
but complains this morning of oppression at the 
stomach, and nausea. The injections of soup 
and brandy were given without tincture of opium, 
in the hope that the bowels would be excited to 
action. But as this effect did not take place, an 
emollient enema was ordered ; and as it did not 
soon operate, w r as repeated in a few hours, being 
made cathartic by the addition of muriate of 
soda. One composed of soup and brandy had 
been given in the interval. Before the bowels 
were moved, she became much oppressed at the 

28 



218 CASES OF THE EPIDEMIC, 

stomach, and vomited a little, and felt a strong, 
but ineffectual desire to vomit more. T there- 
fore gave her ten grains of sulphate of zinc, 
which caused her to throw up immediately, a 
considerable quantity of black flaky matter, sus- 
pended in a large quantity of thin watery fluid. 
The vomiting was not repeated, nor was it follow- 
ed by any nausea. About the same time she 
had a copious discharge from the bowels, and 
immediately after, sunk into a state of exhaustion 
similar to that, of the evening of the 21st, but less 
complete. While in this state she would take 
nothing but cold water. In a few hours, however, 
she again commenced with wine, and the other 
articles which she had previously taken. The 
compound tincture of cinchona was tried now, as 
it had been before, but she could not take it. 
The injections of soup, &c. were continued every 
three hours. Towards evening she became quite 
comfortable, and continued so through the great- 
er part of the night. 

24th. — Towards morning, she began to complain 
of oppression at the stomach, and refused almost 
entirely to take either medicine or nourishment. 
Finding that I could not remove the oppression 
by cordials, after a few hours, I gave her another 
emetic of sulphate of zinc, which operated favour- 
ably, and brought up a considerable quantity of 
a greenish brown viscid slime. About the same 



CASES OF THE EPIDEMrC. 219 

lime, she had a spontaneous discharge from the 
bowels. She was considerably exhausted, but re- 
vived much sooner than before. Injections of 
yeast and soup,with a drachm and a half of powder- 
ed cinchona, were now ordered to be administered 
every four hours. The wine, and medicines were 
to be continued by mouth, as she could take 
them. 

25th. — She has had a good night, and is very 
comfortable. The bowels were moved this 
morning by an emollient enema. She was some- 
what exhausted by its operation, but by no means 
to the degree, in which she had been affected, 
the preceding days. 

From this time she recovered very rapidly. 
She took wine, brandy, cinchona either in de- 
coction or tincture, and soup, varying the quan- 
tity according to circumstances. The stimulant 
and nourishing injections were continued two or 
three days longer, until she could take a suffi- 
cient quantity of medicine and food by mouth. 
In about a fortnight from this time she was able 
to ride out. 



CHAPTER V. 



REMARKS UtON THE CASES AND TREATMENT. 

It will readily be observed, that the treatment 
here described, was not such a course of indiscri- 
minate exhibition of stimulants, as those who 
disapproved of blood-letting, and other copious 
evacuations in this Epidemic, are supposed to 
have pursued. Stimulants it is true, were fre- 
quently administered, and in some cases very 
freely ; but they were not prescribed, without a 
rigid attention to the symptoms which indicated* 
or which at least appeared, to indicate them. 
The principal reliance for the removal of the 
fever, was upon a vigorous course of alteratives, 
aided by the application of external warmth and 
moisture ; and stimulants were chiefly given, to 
prevent, and remove the prostration and debility 
which the fever generally produced. 

It is not my intention to enter into an argu- 
ment in favour of the practice which I adopted. 
It has been faithfully detailed in the preceding 



REMARKS, &C. 221 

pages, and the result fully exposed ; so that the 
reader may judge for himself, of its propriety. 
Whatever errors or defects there may have been 
in the particular details, yet I am persuaded that 
when all the circumstances are taken into view, 
the success will be considered sufficient to justify 
the general system pursued. 

When the violence of the disease is fully con- 
sidered, the suddenness of its attack, and the de- 
ceptiveness of its symptoms; the difficulty, and 
frequent impossibility of procuring suitable at- 
tendants; the scattered situation of many of the 
patients, and the consequent delay in calling 
advice ; and the scantiness with which many of 
them were supplied with the comforts of life ; I 
am confident that the number of unfavourable ter- 
minations was not so great, as to be thought a re- 
proach to the medical treatment under which they 
occurred. Let it not be forgotten, that the state- 
ment of fatal cases is not confined to the deaths 
which were, strictly speaking, occasioned by the 
fever, nor to any limited period of the Epidemic, 
in which the practice was more successful than at 
other times. It applies to the whole course of 
the Epidemic, and to every death occasioned in 
any degree by it, in my practice. 

A much larger proportion of fatal terminations 
appear among the cases given, than occurred in 



'I'l'l REMARK.- UPQN THE 

actual practice ; because in these, the disease 
may be supposed to be more fully developed, 
and to exhibit more completely its real character. 
Yet, the result in these cases, can hardly be at- 
tributed to a deficiency of healino power in the 
remedies employed, considered as applicable to 
the disease itself, in distinction from the contin- 
gent circumstances, to which all diseases are liable. 
This remark will apply to nearly, or quite every 
fatal case of the Epidemic which occured in my 
practice. There was some peculiar circumstance, 
in the constitution or habits of the patient, or of 
gross mismanagement on the part of the attend- 
ants, which made it impossible to pursue the 
treatment relied upon in other cases. 

It is in my view, of great importance in the 
management of this disease, to bear constantly 
in mind the maxim of Sydenham, that Epidemics 
assimulate to themselves all other diseases, which 
occur in their progress. To the neglect of this 
maxim, I attribute many of the unfavourable 
terminations of the disease in various parts of 
the country. In some places where the Epidemic 
prevailed, those who were affected with the sim- 
ple form of the fever, almost uniformly recover- 
ed, while those in whom it was complicated with 
an affection of the chest, as uniformly died. In 
the simple form of the disease, the symptoms di- 
rectly point out the proper course for their re- 



CASES AND TREATMENT. 223 

moval. In the complicated form, those symp- 
toms are deceptive, and lead to an erroneous 
practice, unless corrected by the maxim just 
mentioned. 

It is indeed true, that there was a very great 
variety of symptoms and appearances in different 
patients ; and of course, a corresponding variety 
was requisite in the modes of practice, in order 
to adapt the remedies to the individual cases. 
But it is equally true, that there were certain 
general features, and habits, which were common 
to all, and which, if they do not prove the dis- 
ease to be the same, at least, shew that it always 
belonged to the same family. 

This uniformity of disease does not extend so 
far, as to justify a physician in prescribing with- 
out a rigid and careful attention to the particu- 
lar symptoms of each individual case ; much less 
in opposition to the indications of those symp- 
toms. On the contrary, it is a motive and an 
important one, for extending the investigation 
farther, and shews the necessity of considering 
the symptoms, not only in relation to each other, 
in the case before him, but also in relation to 
other diseases by which it may be surrounded. 
It certainly is matter of observation, and not of 
theory merely, that acute diseases vary very 
much at different times, in the extent to which 
they require evacuations, and the facility with 



224 REMARKS UPOJV THE 

which they bear them. This remark is true not 
only as applicable to particular cases of the 
same disease, but also in reference to nearly or 
quite all the diseases in the different periods in 
which they occur, whether they are epidemic or 
merely occasional. 

This perhaps amounts to no more than that 
the predisposing cause of disease, being general 
in its nature, applies to all the disorders of any 
particular period, and has an influence upon 
them, although of various kinds; at the same time, 
this cause, being different, in different periods, 
varies in the nature and tendency of its influence 
upon diseases, which, but for these variations, 
would be the same in all seasons. But however 
it may be explained, the principle is sufficiently 
well established by observation, and cannot be 
disregarded in practice with impunity. 

To apply these remarks to the disease under 
consideration ; considering it, as I do, a disease 
of debility, requiring, in general, a powerful 
course of stimulants, and yet sometimes compli- 
cated with symptoms of inflammation and excite- 
ment ; I would not by any means, when these 
symptoms are present, so far neglect them as to 
continue the same vigorous stimulant course as 
in other cases. Neither, on the other hand, 
would I prescribe depleting remedies with the 
same freedom, as at other times, when no such 



CASES AND TREATMENT. 225 

tendency to debility prevailed. I would take the 
middle course, and cautiously take such measures 
as should relieve the inflammation, with the least 
possible diminution of strength ; and at the same 
time support the strength by such means, as w T ould 
have the least tendency to increase the inflame- 
mation. 

This course was perfectly successful ; and in 
the complicated cases the patients recovered 
with as much facility as in others. The inflam- 
mation was in no instance so severe, as to require 
very powerful evacuations. Blistering and diar 
■phoretics were sufficient to remove it : and as 
they exhaust the strength less rapidly than other 
evacuants, they were always preferred. The 
only instance in which I felt any inclination to 
bleed during the Epidemic, was that of Mrs. H. 
case VI. Her pulse was hard, and other symptoms 
seemed to indicate such an evacuation. But 
having learned how exceedingly unsuccessful 
the practice of bleeding had been in other towns 
in the vicinity, and having observed myself with 
what extreme rapidity the strength sunk in other 
cases under slighter evacuations, I was induced 
to defer it; though with a full resolution to re- 
sort to it, unless the measures which were adopt- 
ed had given speedy relief. The result shews, 
that, whatever might have been the effect of a 
different proceeding, very little can have been 
lost by that which was adopted. 

29 



CHAPTER VI. 



REMARKS ON THE NATURE OF THE DISEASE. 

It cannot be necessary to shew that the Epi- 
demic, the history of which I have given, was a 
Fever, although there was hardly a symptom, of 
those which usually enter into the description of 
that disease, which was not occasionally wanting. 
In all cases it presented such a collection of ap- 
pearances, as could not well be mistaken by a 
physician, however anomalous in their order, and 
arrangement. The whole inquiry then, is into 
the nature and character of the fever as such. 

It has become customary to give the name of 
typhus to all fevers, in which prostration and ex- 
haustion are prominent symptoms, however vari- 
ous their character in other respects. If this is to 
be regarded as a general distinction merely, ex- 
pressive of the debility which accompanies fever, 
it obviously includes the disease which is describ- 
ed in the preceding pages. But if typhus is to be 
considered as a particular disease, the fever under 
consideration was not a typhus ; for it did not exhi- 



REMARKS, &C 227 

bit the characteristic symptoms, which belong to 
that disease. It had not the regular approach, nor 
the uniformity of appearance, of typhus. Its pro- 
gress was more rapid, its features more variable, 
its changes more abrupt, and its termination more 
sudden. 

These are obviously characters of different 
diseases ; and in practice, nothing can be easier 
than to distinguish them. A very slight examina- 
tion is sufficient to shew that we have met a very 
different fever, from that which has long been 
known as typhus. 

Yet this was a disease of debility ; and of very 
great debility. I am aware of the distinction 
between mere prostration of strength, and debi- 
lity. The fever under consideration exhibited 
them both ; and in a very powerful degree. The 
strength was not only oppressed by the impulse 
of disease, but it was rapidly exhausted. To 
adopt the comparison of Fordyce, the spring was 
not only overpowered, so as to prevent its action, 
but its elasticity speedily vanished under the 
weight, which pressed upon it. 

It is of very little importance in a practical 
point of view, whether, after this debility had 
actually commenced, it was preceded by a state of 
excitement or not ; or in the language of Brown, 



228 REMARKS ON THE 

whether it is to be considered as direct or indirect. 
It is a state of real debility, to which the physi- 
cian is called, and for which he is to prescribe, 
however it may have been induced. Whatever ex- 
citement there may have been, if indeed there 
had been any, has disappeared before he arrives. 
Surely he is not to imagine a secret influence, and 
prescribe for occult causes of disease, of whose 
existence the symptoms give no evidence. De 
non existentibus et non apparentibus, eadem esi 
ratio, is a maxim which ought to be adopted in 
medicine, as well as in law ; provided proper 
care is taken to elicit all the evidence, which the 
appearances of disease actually exhibit to the at- 
tentive observer. 

There seems to me to be no sufficient ground 
for the supposition, w 7 hich appears of late to be 
extensively adopted, that the primary effect of 
an attack of disease, of whatever nature, is an ex- 
citement of the vital pow T ers ; and that the debility 
which is produced, is in the first instance, ex- 
clusively an indirect result of this excitement. 
I see no good reason why we may not as well 
suppose, that the first effect of an attack of disease 
should be depression, as that it should be excite- 
ment. It is undoubtedly true, that in some instan- 
ces, diseases of excitement have been mistaken for 
those of depression, in consequence of the decep- 
tive appearances produced by the prostration of 



NATURE OF THE tMSEASE. 229 

strength. But that this is always the case, and thai 
no diseases of direct depression occur, is an as- 
sumption altogether hypothetical. 

Indeed, the whole reasoning upon this subject 
is in a great measure hypothetical. We are ac- 
customed to refer to the heart and arteries, for the 
primary effects of an attack of fever ; and every 
thing capable of producing a change of action in 
these organs, being considered as a stimulus the 
result is of course, an excitement. Yet it is not 
at all certain, that the febrile action does in fact 
commence in the arterial system ; nor that sti- 
muli are the only agents, of whose action that 
system is susceptible. The very nature of the 
subject precludes the possibility of any positive 
knowledge in regard to it. We cannot at all 
conceive, in what manner a cause of disease 
which is perfectly invisible, and of whose nature 
we are entirely ignorant, should be able to pro- 
duce any action whatever in a living, healthy 
system. Much less, can we investigate the na- 
ture of this action. It is as natural, and it appears 
to me to be as rational, to suppose it to be a de- 
pression, as an excitement of the vital powers. 
All that we can know of it, is from its effects ; 
and they are sometimes of one kind and some- 
times of the other. Why then should we resort 
to the supposition, that they are uniform in their 
nature, but that their character is sometimes con- 
cealed by deceptive symptoms ? 



230 REMARKS OS I THE 

This is in reality the position of those who 
insist that all febrile diseases, are originally dis- 
eases of excitement. A circumstance very much 
relied upon, in support of the position, is the con- 
gestion in the head, which frequently takes place 
in diseases of this class, and the appearances after 
death, produced by it. But if carefully examin- 
ed, the inference deduced from this circumstance 
will hardly appear to be well founded. It is, I 
believe, universally agreed, that the congestion 
is principally, if not entirely, venous. It may 
therefore, as readily be produced, by a debility 
of the venous system, by which the return of the 
blood is retarded, as by an increased action of the 
heart and arteries, which should throw a larger 
quantity of that fluid into the head. There is, 
for ought I can see, as much probability in the 
hypothesis, that the morbid influence, whatever 
it may be, acts upon the brain, inducing debility 
of its vessels and its functions, as in that which 
supposes it to act primarily upon the heart. The 
impressions which the former organ is capable of 
receiving from external objects are, at least, as 
direct, and as powerful, and its sympathies with 
other parts of the body as extensive, as those of 
the latter. Why then, should it not be as sus- 
ceptible to injuries, whether received directly 
from without, or from sympathetic actions within ? 

Unless the vital powers are very much over- 
powered, an obstruction in the circulation, na- 



NATURE OF THE DISEASE. 231 

turally occasions a re-action of the heart and ar- 
teries, by which an effort is made for its removal. 
Hence the excitement which follows, may itself 
be the consequence of the debility which pre- 
ceded it. The effort indeed is often a vain one ; 
and the congestion remains until it is relieved by 
art. In other instances, the first impression of 
disease is so violent, as to preclude all re-actioh, 
and no excitement follows the attack. Thus we 
not unfrequently see men of robust habits, and 
vigorous constitutions, rapidly sink under the 
operations of a fever, without any of the symp- 
toms which mark a resistance to its power ; while 
in persons of feebler habits, affected by the 
same disease, we as often witness an excitement 
much more active. 

That congestion is sometimes (for I do not pre- 
tend that it always is) produced by debility, ap- 
pears from its being effectually removed by the 
application of stimulants. Upon the other hy- 
pothesis, these remedies ought always to increase, 
instead of diminishing the coma, and other symp- 
toms of congestion, which so frequently occur 
in fever. How far this is from being the case, ap- 
pears from the history given in this volume. I 
am aware that it has been said, that it was only in 
very slight cases of disease that these remedies 
are ever successful, and that if recoveries 
take place, it is in defiance of remedies. But 



232 REMARKS OJN THL 

such remarks are not made in the spirit of accu- 
rate investigation, which ought to characterize 
researches, in a profession avowedly founded up- 
on experience and observation ; and are incon- 
sistent with the candour and liberality, which 
ought to govern its members. If I am not greatly 
mistaken, the preceding pages furnish abundant 
evidence, that stimulants do, sometimes at least, 
promptly and effectually remove the symptoms 
of powerful and extensive congestions. 

This explanation is confirmed by the fact, as ob- 
served by Armstrong, that excessive blood-let- 
ting will sometimes produce a similar congestion, 
and occasion the same appearances on dissection. 
" It is also remarkable," says that excellent author, 
"that on examining the bodies of some patients 
who had lost great quantities of blood in this way, 
I found much congestion in the veins of the brain 
and liver, with more or less serum effused in 
some parts."* Indeed it was very observable, 
during the Epidemic at Gardiner, that evacua- 
tions of every kind, invariably increased the ten- 
dency to coma, and that tonics and stimulants 
cautiously administered, as constantly diminish- 
ed it. 

* Armstrong on Typhus and other febrile diseases, p. 187. 



NATURE OF THE DISEASE. 233 

Whether this view of the subject be correct or 
not, is a question of minor importance, in res- 
pect to the propriety of the practice detailed in 
this volume, as having been adopted in the Epi- 
demic of 1814. As I have before observed, in 
the more violent cases, at least, this was a disease 
of real debility. If there had been excitement, it 
had vanished, before it could shew itself by symp- 
toms. If we must with Armstrong;, suppose a 
state of excitement, it must also be allowed, that 
the disease passed with extreme rapidity to his 
third stage of collapse. Surely, if a state of cold- 
ness, listlessness and topor, without any subse- 
quent heat ; of extreme prostration and exhaus- 
tion, which are invariably increased by every 
species of evacuation, and as invariably diminish- 
ed by tonics properly administered ; a puise soft, 
feeble, and quick, which almost vanishes under 
the finger, as if crushed by its weight, and which 
every evacuation renders still more feeble and 
tremulous ; if these are not unequivocal marks of 
debility, I know not the points which are to guide 
us in practice. 

The only practical question is, whether in 
the first moments of the disease, a powerful eva- 
cuant might not arrest the progress of the disease, 
and prevent the subsequent debility. This must 
be decided by observation, not by theory. When 
a physician finds symptoms of excitement in a 

30 



234 REMARKS OX THE 

disease usually attended with great debility, his 
object must be, to determine by what means this 
excitement and its causes, can be removed with 
the greatest promptness, and the least subsequent 
inconvenience. In many, perhaps in most, cases, 
the evils consequent to active depletion will be 
less urgent, than those occasioned by suffering 
the excitement to be overcome by the progress of 
the disease. Yet in other cases, the tendency to 
debility and exhaustion may be so extreme, as to 
render it safer to trust, not indeed to the efforts 
of nature, but to mild evacuants and powerful 
alteratives for the removal of the excitement ; 
while the strength is supported by such means as 
shall not interfere with the oreneral indication. It 
cannot be doubted, that each of these cases 
occur : and it is upon them that the two sys- 
tems of practice are founded, which at first view 
seem so opposite, and about which the medical 
world have been so divided. It is the business 
of the physician to inquire which method promis- 
es the most success in the case before him ; and 
he will find his answer, in a careful comparison of 
the results in analogous cases about him, with 
the symptoms, constitution and habits of his 
patient. 

In the fever at Gardiner, the great tendency to 
debility from slight evacuations, which came under 
ray own observation, and the accounts which I 



NATURE OF THE DISEASE. 235 

received of the fatal effects of more powerful de- 
pletion in many cases in the vicinity, induced me 
to prefer the alterative course. I will not pre- 
tend to say, that there might not have been cases, 
in which bleeding would have had a good effect. 
But I think, I may safely appeal to the result, as 
a proof, that my patients did not generally suffer 
for the want of it. 

In all the cases, in which there was any appear- 
ance of excitement, it was mild, and yielded rea- 
dily to the remedies prescribed for it. It is wor- 
thy of remark, that no case, in which I could dis- 
cover marks of excitement or inflammation at the 
commencement, was followed by the great de- 
pression and coma, characteristic of the worst 
cases ; except where some circumstances, acci- 
dental fo the disease, occurred to produce them, 
as in case V. If I may not quote this fact as a 
confirmation of my position, that the debility was 
not always preceded by a state of excitement, I 
may at least consider it as evidence, that in the 
worst cases, the excitement had passed away, be- 
fore I was called to prescribe. 

Where the existence of excitement is fully es- 
tablished, it does not follow as a matter of course, 
that an active anti-phlogistic mode of treat- 
ment is the most suitable ; because in many in- 
stances, milder means may be sufficient to accom- 



236 REMARKS ON THE 

plish the desired object, with less expence of 
strength; and in others, the debility produced by 
the evacuations may be more urgent, than would 
be occasioned by the disease without them. There 
can therefore be no general rule, to guide the phy- 
sician in his selection of the course he will pursue. 
He must be governed by the nature and symp- 
toms of the case before him. 

There may be, and doubtless frequently are cases, 
in which the circumstances are so nicely balanced 
in favour of each course, as to render it questiona- 
ble, which is to be preferred ; and in which either 
if prudently managed will be successful. Hence 
the reason, why such apparently different modes of 
treatment, succeed in the same disease with differ- 
ent practitioners. Even in some cases where 
there is congestion without excitement, it is pos- 
sible that bleeding may sometimes so suddenly di- 
minish the fullness of the veins, as that the relief 
of the congestion, and the consequent reaction, 
shall compensate for the debility which it will pro- 
duce. In such a case, this evacuation would not 
be at all inconsistent with a simultaneous exhibi- 
tion of tonics and stimulants, such as the symptoms 
might indicate. 

Such are my views of the fever under consi- 
deration, in its more simple form. It was strictly 
adynamic in its character, and required to be treat- 



NATURE OF THE DISEASE. 237 

ed as such. But there was a class of symptoms, 
which appeared in a considerable number of cases, 
that are not at all explained by what has been said. 
I allude to the affections of the chest, which have 
been so often mentioned in the historical part of this 
treatise. I regard these affections as stiictly inflam- 
matory; although they are to be carefully distin- 
guished from primary inflammations, as well as from 
the inflammatory diathesis, described by the older 
writers. Much confusion has arisen from neg- 
lecting this distinction. When the local affection 
in this fever is called an inflammation, some phy- 
sicians seem to understand by the term, either a 
genuine pneumonia, or an inflammatory fever, 
such as is described by Sydenham; and they 
strenuously deny that it was either. 

But it does not follow, that a local inflamma- 
tion should necessarily have such an effect on the 
constitution, as to render the whole disease inflam- 
matory. Typhus fever complicated with inflam- 
mation, is sufficiently common ; and although the 
local affection, when it is severe, modifies the 
treatment proper for the general disease, yet it 
does not so far change the nature of that disease, 
as to require such a course of treatment as would 
have been proper, if it had been originally inflam- 
matory. The effect in this Epidemic was pre- 
cisely analogous. The cases, in which there was 
an affection of the chest, exhibited a less rapid and 



238 REMARKS OS THE 

urgent depression of strength, and required more 
evacuations and fewer stimulants than others ; al- 
though the inflammation was not so powerful as 
to need very active depletion, for its reduction. 

Some of the most inflammatory cases are given 
in this voiume. It will be seen that they in no 
instance amount to the Peripneumonia Notha of 
medical writers. The symptoms of inflammation 
were milder, and more readily and speedily sub- 
dued without bleeding, than in that disease ; par- 
ticularly in its epidemic state, as described by 
Gallup and Thatcher. Indeed these symptoms 
were so mild, in the Epidemic in Gardiner and the 
vicinity, and yielded so easily without the use of 
powerful anti-phlogistic remedies, that some gen- 
tlemen were induced to consider them merely as 
the effect of congestion, without inflammation. 

This explanation is not necessary to the theory 
of the disease, and in my view is not at all satisfac- 
tory. The symptoms and changes which in other 
cases are ascribed to inflammation, were produced 
by this affection ; and although milder in decree, 
their nature may nevertheless have been the same. 
We had the same pain in the chest, difficulty of 
breathing, and cough, followed by a copious 
yellowish expectoration, sometimes streaked with 
blood, as in genuine pneumonia ; and not unfre- 
quently, in the commencement of the disease, the 



NATURE OF THE DISEASE. 239 

pulse was considerably harder than in other cases 
of the fever. If these symptoms had not readily 
yielded to the milder measures adopted for them, 
I should not have hesitated to recommend bleed- 
ing. As it was, this evacuation did not appear to 
be necessary ; and I cannot pretend to say, with 
positiveness, what would have been the result. 
Bat I shall not willingly believe that there would 
have been any danger in following with caution 
and circumspection, the indications which the 
symptoms pointed out, corrected as they would 
be, by comparing them with the other cases which 
prevailed at the time. 

That this affection was in fact inflammation, is 
still more probable from the great disposition to 
local inflammations, of a less important character, 
upon the surface of the body. We have seen 
that carbuncles and other inflammatory sores, 
were a very frequent occurrence. The action 
necessary to produce these, must have been simi- 
lar in kind, though perhaps not in degree, to that 
which should produce an inflammation of the 
lungs, sufficient to occasion the peripneumonic 
symtoms in these cases. 

In a very few cases, the disease appears to have 
commenced with congestion in the head, and pro- 
bably in other internal organs. Case XXIII, was 
of this kind, and in a slighter degree, case XX. 



240 REMARKS ON THE 

The listlessness and torpor in these eases were 
different in their appearance from the coma and 
stupor which were common, at a later period of 
the disease. Both classes of cases were relieved 
by stimulants, always combined in the former, 
with powerful diaphoretics. I did not practice 
blood-letting to relieve this congestion, and there- 
fore can say nothing of its effects. Whatever 
may be thought of its efficacy or fitness to remove 
the symptoms, there can be no very powerful rea- 
son, to complain of the practice which was adopted, 
since in every instance of this kind, the result was 
favourable. 

I have thus applied to the Epidemic under con- 
sideration, the distinctions which Dr. iVrmstrong 
has adopted in his "illustrations of Typhus." 
There are many points in which the two diseases 
resemble each other. Yet there are others, 
equally important, in which they evidently differ. 
Several of these have been mentioned, at the com- 
mencement of this chapter. There is one other 
circumstance of difference, deserving of notice, 
which was omitted there, because its correctness 
may not perhaps be universally allowed, without 
further illustration. Typhus is every where de- 
scribed as a contagious disease ; while the Epidemic 
which has so extensively ravaged our country, is 
generally believed not to be contagious. This is 
fully my own opinion, and so generally is it es- 



NATURE OF THE DISEASE. 241 

tablished, that I should not think it necessary to 
say any thing in its support ; were it not that the 
contrary opinion is held by some gentlemen, for 
whom I have a high respect. The consequences 
of believing the fever to be contagious, have in 
some instances been very distressing. I have 
known sick families to suffer much, from the neg- 
lect of their friends ; occasioned by the dread of 
becoming infected. It is a matter of some prac 
tical importance therefore, to ascertain the cor- 
rectness of opinions upon this subject. 

That contagion, was not the sole cause of the 
extension of the Epidemic ; is obvious from only 
a very slight attention to the facts mentioned in 
the chapter upon the character of the disease. 
It often attacked persons, who previously had 
never been within the sphere of its influence, how- 
ever contagious it might be supposed to be. At 
the same time, it frequently happened that one 
individual in a family, was affected, and went 
through a course of it, while all the rest of the 
family escaped ; and in two instances the fever prov- 
ed fatal to the only person in the family, who was 
attacked. These facts are not consistent with 
the supposition of a very active degree of con- 
tagion. 

It is indeed true, that when the fever appeared 
in a family, there seemed many times a disposition 

31 



242 REMARKS ON THE 

to extend the number of its victims, beyond those 
first attacked. But besides that they all must pro- 
bably have been equally exposed to the remote 
cause of the disease, this may be accounted for, 
by the great fatigue and anxiety, which a state of 
sickness occasions. Wherever that happened, 
those members of the family, who had been the 
least constantly in the sick room, were as frequent- 
ly attacked, as others who had been uniformly en- 
gaged about the sick-bed. There were a few 
persons, who were almost continually employed, 
through the whole period of the Epidemic, in at- 
tending upon the sick, and occasionally, in per- 
forming the last offices for the dead, without being 
at any time attacked by the fever. These facts 
appear to prove, as strongly as a negative can well 
be proved, that this was not a contagious disease. 

It is a question of considerable importance, in 
regard to this treatise, whether the Epidemic at 
Gardiner, was the same disease as that which has 
prevailed so extensively throughout New-En- 
gland ; in other words whether it was the spotted, 
or petechial, fever. If it was a mere local disease, 
confined in its operations to the sphere in which 
these observations were made, its history and de- 
scription, are of very little comparative conse- 
quence to the medical world. But if it was in 
fact the same disease which has spread devastation 
and alarm through the country, every faithful at- 



NATURE OF THE DISEASE. 243 

tempt to elucidate its character, is entitled to some 
attention. 

So far as accounts have been published, and as 
my information extends, the general features of 
the Epidemic seem to have been the same, where 
ever it prevailed. Yet in some particulars, it 
varied considerably, in different places. Its pro- 
gress was more rapid in some places than in others ; 
and the treatment required was different, as well 
as the success resulting from the treatment. If 
the view which I have taken of the nature of the 
disease be correct, it furnishes a ready explanation 
of the various appearances, which were presented 
in its course. We have seen how varieties in the 
violence of the attack, as well as in the constitu- 
tion and habits of patients, may produce corres- 
ponding varieties in the symptoms of the disease, 
and in the treatment which it will require ; and 
yet its essential characters remain the same. In 
like manner, the peculiarities of local situation, 
may so influence an Epidemic as to alter many of 
its symptoms, without changing the nature of the 
disease in general. 

It is very obvious, that the Epidemic under 
consideration, exhibited more strongly marked ap- 
pearances of inflammation, and less urgent ten- 
dency to debility, in some stages of its progress, 
and in some places where it raged, than in others. 



244 REMARKS, &C. 

Yet there was not a corresponding difference in 
the other symptoms, by which it was attended. 
There were important features in its character, 
which a physician would every where detect, whe- 
ther connected with the highest state of excite- 
ment, which the disease ever assumed, or with the 
lowest state of depression. So far therefore as 
these constituted the disease, it is to be considered 
as the same, in all its varieties ; but modified in 
different places by circumstances accidental to it. 

Of the name, which it is proper to affix to this 
disease, little need be said. It is evident that no 
name descriptive of its character and symptoms, 
can be applicable to all its varieties of appearance. 
It would doubtless be better therefore, not to at- 
tempt any such description, in the term by which 
the Epidemic is to be known. A variety of names 
have been invented ; but none of them seem to be 
satisfactory, except to their authors. That it was 
a fever, all agree ; and that it was adynamic in 
its character, is nearly as universally allowed. 
More than this must be learned, by referring not 
to the name, but to the description of the disease. 



CONCLUSION. 



Whatever may be thought of the opinions 
advanced in this volume, or of the propriety of 
the practice, which was adopted in the disease de- 
scribed in it ; I flatter myself that the details of 
facts which it contains, will enable the reader to 
draw for himself some inferences of practical 
utility. One inference only, I will mention, be- 
cause it seems to have been too much overlooked. 
It is, the importance of bearing it constantly in 
mind, in investigating the character of an Epidemic, 
that it is to be sought, like that of every other dis- 
ease, only in the symptoms and appearances which 
the disease assumes. When the late Epidemic first 
appeared in the country, it seems in many places, to 
have been regarded, not only as a new disease, but as 
a disease subject to new laws; and requiring new 
principles to guide the physician in its treatment. 
The practice was therefore almost exclusively 
empyrical. The knowledge of ages was thrown 
away, as inapplicable, and the suggestions of the 
moment, often the result of terror or caprice, 
adopted in its stead. Who does not now see, that 
but for the belief that this was an evil, to which 
the race of man had not before been subject, its 



246 CONCLUSION. 

progress would have been less destructive I Had 
physicians in their first researches into the cha- 
racter of this Epidemic, been more generally guid- 
ed by the lamp which the science ever holds out, 
we should sooner have been acquainted with its 
nature. Had they applied to this disease, the 
knowledge which they possessed in relation to all 
others, we should not have been so long terrified 
by its ravages, before we had learned to resist 
them. There were indeed many who did this; 
and it is to them that the profession is indebted for 
stripping the Epidemic of its terrors, and present- 
ing it to us, shorn of its locks, and weak like 
other diseases. 



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